Provider Demographics
NPI:1669755120
Name:DAVIS, LAURIE ERIN
Entity type:Individual
Prefix:MISS
First Name:LAURIE
Middle Name:ERIN
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 1:2300 FAIRVIEW RD APT T202
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-6438
Mailing Address - Country:US
Mailing Address - Phone:760-840-0764
Mailing Address - Fax:714-668-6194
Practice Address - Street 1:2300 FAIRVIEW RD APT T202
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-6438
Practice Address - Country:US
Practice Address - Phone:760-840-0764
Practice Address - Fax:714-668-6194
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health