Provider Demographics
NPI:1649488396
Name:MACDAVID, ANNE WHITTLESEY (MS, MFT)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:WHITTLESEY
Last Name:MACDAVID
Suffix:
Gender:F
Credentials:MS, MFT
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:W-
Other - Last Name:MACDAVID
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, MFT
Mailing Address - Street 1:4 COFFEEBERRY CT
Mailing Address - Street 2:
Mailing Address - City:COTO DE CAZA
Mailing Address - State:CA
Mailing Address - Zip Code:92679-4945
Mailing Address - Country:US
Mailing Address - Phone:949-322-2331
Mailing Address - Fax:949-858-2408
Practice Address - Street 1:4 COFFEEBERRY CT
Practice Address - Street 2:
Practice Address - City:COTO DE CAZA
Practice Address - State:CA
Practice Address - Zip Code:92679-4945
Practice Address - Country:US
Practice Address - Phone:949-322-2331
Practice Address - Fax:949-858-2408
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 42748106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist