Provider Demographics
NPI:1992012652
Name:DAVIDSON, CHARLES A (LMFT)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:A
Last Name:DAVIDSON
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7801 ACADEMY RD NE
Mailing Address - Street 2:BLDG 2 SUITE 200
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-3379
Mailing Address - Country:US
Mailing Address - Phone:505-262-9391
Mailing Address - Fax:505-265-7860
Practice Address - Street 1:7801 ACADEMY RD NE
Practice Address - Street 2:BLDG 2 SUITE 200
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-3379
Practice Address - Country:US
Practice Address - Phone:505-262-9391
Practice Address - Fax:505-265-7860
Is Sole Proprietor?:No
Enumeration Date:2010-09-01
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0927106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist