Provider Demographics
NPI:1043588643
Name:CAMPOS-DAVIDS, IARA MARIA (MFT)
Entity Type:Individual
Prefix:
First Name:IARA
Middle Name:MARIA
Last Name:CAMPOS-DAVIDS
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2528 WASHINGTON WAY
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-5326
Mailing Address - Country:US
Mailing Address - Phone:510-520-5465
Mailing Address - Fax:
Practice Address - Street 1:2086 COMMERCE AVE
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-4902
Practice Address - Country:US
Practice Address - Phone:925-260-0318
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-09
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 78179106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist