Provider Demographics
NPI:1457789240
Name:DAVIS, VIVIAN (MHR)
Entity Type:Individual
Prefix:
First Name:VIVIAN
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MHR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:655 PAGE ST
Mailing Address - Street 2:4
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94117-2567
Mailing Address - Country:US
Mailing Address - Phone:918-381-1978
Mailing Address - Fax:
Practice Address - Street 1:333 7TH ST
Practice Address - Street 2:SUITE 401
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-4031
Practice Address - Country:US
Practice Address - Phone:415-252-1853
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-15
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100746170GMedicaid