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General NPI Number Information
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NPI Number | 1629418710
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Entity Type | Individual
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Provider Name | REDD EDEEJAHNAI DAVIS
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Gender | Female
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Dates
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Enumeration Date | 07/03/2013
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Last Update Date | 04/22/2023
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Provider Practice Location Address
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Address Line | 3095 CHRISTIANNE CIR
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City | HEMET
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State | CA
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Zip | 92545-1592
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Country | US
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Telephone | 951-880-5597
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 281
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City | SAN JACINTO
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State | CA
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Zip | 92581-0281
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Country | US
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Telephone | 951-880-5597
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | ASW63685
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License Number State | CA
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