Provider Demographics
NPI:1265256101
Name:HADRABA DAVIS, KATE ELIZABETH
Entity type:Individual
Prefix:
First Name:KATE
Middle Name:ELIZABETH
Last Name:HADRABA DAVIS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3017 DOUGLAS BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-3850
Mailing Address - Country:US
Mailing Address - Phone:916-241-9496
Mailing Address - Fax:
Practice Address - Street 1:10113 ALTA SIERRA DR
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95949-6896
Practice Address - Country:US
Practice Address - Phone:310-926-3088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-07
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW1264421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical