Provider Demographics
NPI:1265909402
Name:DAVENA, JULIA (RADT)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:DAVENA
Suffix:
Gender:F
Credentials:RADT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7949 CALIFORNIA AVE STE 15
Mailing Address - Street 2:
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-7156
Mailing Address - Country:US
Mailing Address - Phone:916-863-7949
Mailing Address - Fax:
Practice Address - Street 1:7949 CALIFORNIA AVE STE 15
Practice Address - Street 2:
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628-7156
Practice Address - Country:US
Practice Address - Phone:916-863-7949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-25
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1404430920101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty