Provider Demographics
NPI:1386347326
Name:DAVIS, DANITA (LMFT)
Entity type:Individual
Prefix:
First Name:DANITA
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5085 LA JOLLA BLVD UNIT 8
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-1783
Mailing Address - Country:US
Mailing Address - Phone:206-412-3699
Mailing Address - Fax:
Practice Address - Street 1:5085 LA JOLLA BLVD UNIT 8
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109-1783
Practice Address - Country:US
Practice Address - Phone:206-412-3699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-27
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA150364106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist