Provider Demographics
NPI:1508988304
Name:DAVIS, CHRISTIE MAREA
Entity Type:Individual
Prefix:MISS
First Name:CHRISTIE
Middle Name:MAREA
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6253 DOUGHERTY ROAD
Mailing Address - Street 2:#4307
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-2678
Mailing Address - Country:US
Mailing Address - Phone:925-223-7394
Mailing Address - Fax:
Practice Address - Street 1:2275 ARLINGTON DRIVE
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578-1132
Practice Address - Country:US
Practice Address - Phone:510-481-1222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health