Provider Demographics
NPI:1215195722
Name:DAVIS, WANDA ELLIS (MSW)
Entity Type:Individual
Prefix:
First Name:WANDA
Middle Name:ELLIS
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1395 BANCROFT AVE
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-5103
Mailing Address - Country:US
Mailing Address - Phone:510-357-0205
Mailing Address - Fax:510-357-0688
Practice Address - Street 1:1395 BANCROFT AVE
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-5103
Practice Address - Country:US
Practice Address - Phone:510-357-0205
Practice Address - Fax:510-357-0688
Is Sole Proprietor?:No
Enumeration Date:2008-05-30
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker