Provider Demographics
NPI:1114032026
Name:DAVIS, HEATHER DAWN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:DAWN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:HEATHER
Other - Middle Name:DAVIS
Other - Last Name:FINGERLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1501 SAN ELIJO RD S
Mailing Address - Street 2:SUITE 104-128
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-2047
Mailing Address - Country:US
Mailing Address - Phone:760-434-5700
Mailing Address - Fax:
Practice Address - Street 1:7220 AVENIDA ENCINAS
Practice Address - Street 2:SUITE 206
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92011-4690
Practice Address - Country:US
Practice Address - Phone:760-434-5700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 217251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALCS217250OtherBLUE SHIELD OF CALIFORNIA