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General NPI Number Information
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NPI Number | 1548513849
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Entity Type | Organization
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Legal Business Name | LISA A DAVIDSON, PHD, APC
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Dates
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Enumeration Date | 10/24/2012
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Last Update Date | 10/24/2012
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Provider Practice Location Address
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Address Line | 14015 MIDLAND RD
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City | POWAY
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State | CA
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Zip | 92064-3959
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Country | US
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Telephone | 858-672-0130
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Fax | 858-391-0499
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Provider Business Mailing Address
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Address Line | 14015 MIDLAND RD
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City | POWAY
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State | CA
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Zip | 92064-3959
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Country | US
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Telephone | 858-672-0130
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Fax | 858-391-0499
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LISA A DAVIDSON
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Credential | PHD
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Telephone | 858-672-0130
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY19308
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License Number State | CA
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