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General NPI Number Information
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NPI Number | 1902259179
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Entity Type | Individual
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Provider Name | ALLYSHA MARIE DAVIS
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Gender | Female
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Dates
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Enumeration Date | 07/22/2016
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Last Update Date | 04/07/2021
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Provider Practice Location Address
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Address Line | 5815 STODDARD RD STE 600
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City | MODESTO
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State | CA
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Zip | 95356-9041
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Country | US
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Telephone | 209-543-1874
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Fax | 209-543-1869
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Provider Business Mailing Address
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Address Line | 207 E ST STE B
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City | DAVIS
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State | CA
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Zip | 95616-4523
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Country | US
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Telephone | 209-968-0180
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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 | ASW65373
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 98770
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License Number State | CA
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