Provider Demographics
NPI:1689342180
Name:DAVIS, BRANDYN ALISA (ASW)
Entity Type:Individual
Prefix:MRS
First Name:BRANDYN
Middle Name:ALISA
Last Name:DAVIS
Suffix:
Gender:F
Credentials:ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31700 N MITCHELL CREEK RD
Mailing Address - Street 2:
Mailing Address - City:FORT BRAGG
Mailing Address - State:CA
Mailing Address - Zip Code:95437-8347
Mailing Address - Country:US
Mailing Address - Phone:530-208-8335
Mailing Address - Fax:
Practice Address - Street 1:312 S LINCOLN ST
Practice Address - Street 2:
Practice Address - City:FORT BRAGG
Practice Address - State:CA
Practice Address - Zip Code:95437-4416
Practice Address - Country:US
Practice Address - Phone:530-208-8335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-31
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW915531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical