Provider Demographics
NPI:1376943043
Name:DAVIS, JANE CHRISTINE GRAHAM (LCSW)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:CHRISTINE GRAHAM
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:JANE
Other - Middle Name:
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:921 EAST COMPTON BLVD
Mailing Address - Street 2:
Mailing Address - City:COMPTON
Mailing Address - State:CA
Mailing Address - Zip Code:90221
Mailing Address - Country:US
Mailing Address - Phone:310-668-6900
Mailing Address - Fax:
Practice Address - Street 1:921 E COMPTON BLVD
Practice Address - Street 2:
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90221-3303
Practice Address - Country:US
Practice Address - Phone:310-668-6900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-29
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA#72698101YM0800X
CA94015101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health