Provider Demographics
NPI:1720672769
Name:DANIELS-DAVIDSON, CHRISTINA D
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:D
Last Name:DANIELS-DAVIDSON
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 1:1317 N SAN FERNANDO BLVD # 173
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91504-4236
Mailing Address - Country:US
Mailing Address - Phone:702-817-3416
Mailing Address - Fax:
Practice Address - Street 1:1313 N LAMER ST
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91506-1030
Practice Address - Country:US
Practice Address - Phone:027-817-3416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-20
Last Update Date:2021-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVMI3215106H00000X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional