Provider Demographics
NPI:1437360112
Name:DAVIS, AMBER COLLEEN (CAS)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:COLLEEN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 ASTER CT
Mailing Address - Street 2:
Mailing Address - City:HERCULES
Mailing Address - State:CA
Mailing Address - Zip Code:94547-1202
Mailing Address - Country:US
Mailing Address - Phone:510-799-0522
Mailing Address - Fax:510-235-3112
Practice Address - Street 1:820 23RD ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94804-1338
Practice Address - Country:US
Practice Address - Phone:510-229-5000
Practice Address - Fax:510-235-3112
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA03-063603101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)