Provider Demographics
NPI:1669825956
Name:DAVIS, TERI CECILIA (EDD, LCSW)
Entity Type:Individual
Prefix:DR
First Name:TERI
Middle Name:CECILIA
Last Name:DAVIS
Suffix:
Gender:F
Credentials:EDD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 27712
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92198-1712
Mailing Address - Country:US
Mailing Address - Phone:760-891-2333
Mailing Address - Fax:
Practice Address - Street 1:1582 W SAN MARCOS BLVD STE 105
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-4081
Practice Address - Country:US
Practice Address - Phone:760-891-2333
Practice Address - Fax:833-437-8374
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-21
Last Update Date:2019-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW869761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical