Provider Demographics
NPI:1629441761
Name:DAVIS, JORJA R (LMFT)
Entity Type:Individual
Prefix:
First Name:JORJA
Middle Name:R
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17216 SATICOY ST
Mailing Address - Street 2:#323
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91406-2103
Mailing Address - Country:US
Mailing Address - Phone:818-422-0062
Mailing Address - Fax:
Practice Address - Street 1:17216 SATICOY ST
Practice Address - Street 2:#323
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91406-2103
Practice Address - Country:US
Practice Address - Phone:818-422-0062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-11
Last Update Date:2015-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC37521106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist