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General NPI Number Information
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NPI Number | 1932328903
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Entity Type | Individual
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Provider Name | L. JEANNETTE DAVIS D.S.W.
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Gender | Female
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Dates
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Enumeration Date | 04/25/2007
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Last Update Date | 01/23/2010
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Provider Practice Location Address
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Address Line | 1110 CALIFORNIA BLVD SUITE A
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93401-2949
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Country | US
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Telephone | 805-546-2104
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Fax | 805-528-6994
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Provider Business Mailing Address
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Address Line | 1110 CALIFORNIA BLVD SUITE A
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93401-2949
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Country | US
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Telephone | 805-546-2104
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Fax | 805-528-6994
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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 | LCSW 2585
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License Number State | CA
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