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General NPI Number Information
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NPI Number | 1841668217
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Entity Type | Individual
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Provider Name | DIANICA DAVIS LCSW
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Gender | Female
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Dates
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Enumeration Date | 09/02/2015
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Last Update Date | 02/21/2023
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Provider Practice Location Address
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Address Line | 3711 LONG BEACH BLVD STE 4065
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City | LONG BEACH
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State | CA
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Zip | 90807-3315
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Country | US
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Telephone | 323-455-4743
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 356
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City | MONTEBELLO
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State | CA
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Zip | 90640-0356
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Country | US
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Telephone |
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 109815
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License Number State | CA
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