Provider Demographics
NPI:1932328903
Name:DAVIS, L. JEANNETTE (DSW)
Entity Type:Individual
Prefix:DR
First Name:L. JEANNETTE
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:DSW
Other - Prefix:DR
Other - First Name:L. JEANNETTE
Other - Middle Name:
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DSW
Mailing Address - Street 1:1110 CALIFORNIA BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-2949
Mailing Address - Country:US
Mailing Address - Phone:805-546-2104
Mailing Address - Fax:805-528-6994
Practice Address - Street 1:1110 CALIFORNIA BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-2949
Practice Address - Country:US
Practice Address - Phone:805-546-2104
Practice Address - Fax:805-528-6994
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2010-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW 25851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical