Provider Demographics
NPI:1659151181
Name:DAVISSON, CHRISTIANA (MA, QASP-S, RBT)
Entity Type:Individual
Prefix:
First Name:CHRISTIANA
Middle Name:
Last Name:DAVISSON
Suffix:
Gender:F
Credentials:MA, QASP-S, RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4856 W ADAMS BLVD # 1/2
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90016-2846
Mailing Address - Country:US
Mailing Address - Phone:323-422-0853
Mailing Address - Fax:
Practice Address - Street 1:4856 W ADAMS BLVD # 1/2
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90016-2846
Practice Address - Country:US
Practice Address - Phone:323-422-0853
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-02
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician