Provider Demographics
NPI:1588452437
Name:DAVIS, KASHANA (APCC)
Entity type:Individual
Prefix:
First Name:KASHANA
Middle Name:
Last Name:DAVIS
Suffix:
Gender:
Credentials:APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 PHOENIX DR APT 3
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-5338
Mailing Address - Country:US
Mailing Address - Phone:707-631-5153
Mailing Address - Fax:
Practice Address - Street 1:500 UNION AVE
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-6317
Practice Address - Country:US
Practice Address - Phone:707-784-7792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-30
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16952101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health