Provider Demographics
NPI:1730459991
Name:DAVIS, DEBORAH ALISON (MFT)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:ALISON
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3550 WATT AVE
Mailing Address - Street 2:SUITE 180
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95821-2667
Mailing Address - Country:US
Mailing Address - Phone:916-396-4307
Mailing Address - Fax:
Practice Address - Street 1:3550 WATT AVE
Practice Address - Street 2:SUITE 180
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95821-2667
Practice Address - Country:US
Practice Address - Phone:916-396-4307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-05
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC37300106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist