Provider Demographics
NPI:1134933732
Name:DAVIDSON, SHANIC LAURELL (ASW)
Entity type:Individual
Prefix:
First Name:SHANIC
Middle Name:LAURELL
Last Name:DAVIDSON
Suffix:
Gender:U
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:PO BOX 6061
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93703-6061
Mailing Address - Country:US
Mailing Address - Phone:916-759-1293
Mailing Address - Fax:
Practice Address - Street 1:8421 AUBURN BLVD # 162
Practice Address - Street 2:
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95610-0359
Practice Address - Country:US
Practice Address - Phone:916-759-1293
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-04
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW1281471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical