Provider Demographics
NPI:1154636884
Name:DAVIDESCU, SHELLEY (MA IMF)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:
Last Name:DAVIDESCU
Suffix:
Gender:F
Credentials:MA IMF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 N CUYAMACA ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-1809
Mailing Address - Country:US
Mailing Address - Phone:619-448-0420
Mailing Address - Fax:
Practice Address - Street 1:900 N CUYAMACA ST
Practice Address - Street 2:SUITE 110
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-1809
Practice Address - Country:US
Practice Address - Phone:619-448-0420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-18
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63694101YM0800X
106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health