Provider Demographics
NPI:1619112638
Name:DAVIDZENKA, YAQHENIYA (BA CUSTOM AFFAIRS)
Entity Type:Individual
Prefix:
First Name:YAQHENIYA
Middle Name:
Last Name:DAVIDZENKA
Suffix:
Gender:F
Credentials:BA CUSTOM AFFAIRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14558 SYLVAN ST
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91411-2324
Mailing Address - Country:US
Mailing Address - Phone:818-787-4151
Mailing Address - Fax:818-787-2840
Practice Address - Street 1:14558 SYLVAN ST
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91411-2324
Practice Address - Country:US
Practice Address - Phone:818-787-4151
Practice Address - Fax:818-787-2840
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-04
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)