Provider Demographics
NPI:1245696673
Name:DAVIS, ELIZABETH LOUISE
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:LOUISE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:622 SOLANO AVE
Mailing Address - Street 2:
Mailing Address - City:SONOMA
Mailing Address - State:CA
Mailing Address - Zip Code:95476-6134
Mailing Address - Country:US
Mailing Address - Phone:707-849-0941
Mailing Address - Fax:
Practice Address - Street 1:622 SOLANO AVE
Practice Address - Street 2:
Practice Address - City:SONOMA
Practice Address - State:CA
Practice Address - Zip Code:95476-6134
Practice Address - Country:US
Practice Address - Phone:707-849-0941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-14
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst