Provider Demographics
NPI:1093055907
Name:DAVILA, CHRISTY (MS, LMFT)
Entity Type:Individual
Prefix:
First Name:CHRISTY
Middle Name:
Last Name:DAVILA
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 325
Mailing Address - Street 2:
Mailing Address - City:GUERNEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95446-0325
Mailing Address - Country:US
Mailing Address - Phone:707-823-1640
Mailing Address - Fax:
Practice Address - Street 1:16390 MAIN ST
Practice Address - Street 2:
Practice Address - City:GUERNEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95446-9677
Practice Address - Country:US
Practice Address - Phone:707-823-1640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-01
Last Update Date:2017-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA102201106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1093055907Medicaid