Provider Demographics
NPI:1154040582
Name:DAVEY, CALEDONIA
Entity type:Individual
Prefix:
First Name:CALEDONIA
Middle Name:
Last Name:DAVEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 CIVIC CENTER DR STE 202
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92084-6162
Mailing Address - Country:US
Mailing Address - Phone:253-576-1059
Mailing Address - Fax:619-374-7134
Practice Address - Street 1:707 CIVIC CENTER DR STE 202
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92084-6162
Practice Address - Country:US
Practice Address - Phone:253-576-1059
Practice Address - Fax:619-374-7134
Is Sole Proprietor?:No
Enumeration Date:2022-08-29
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician