Provider Demographics
NPI:1598242885
Name:WOLFARTH-DAVIS, LAKIA DANAE (AMFT)
Entity Type:Individual
Prefix:
First Name:LAKIA
Middle Name:DANAE
Last Name:WOLFARTH-DAVIS
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:LAKIA
Other - Middle Name:DANAE
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AMFT
Mailing Address - Street 1:22320 FOOTHILL BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94541-2719
Mailing Address - Country:US
Mailing Address - Phone:510-582-0148
Mailing Address - Fax:
Practice Address - Street 1:22320 FOOTHILL BLVD STE 400
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541
Practice Address - Country:US
Practice Address - Phone:510-582-0148
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-19
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106269106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist