Provider Demographics
NPI:1538368808
Name:DAVIS, DORSHONDA LATOYA (MA, MFT, AMFT, PSYDC)
Entity type:Individual
Prefix:MISS
First Name:DORSHONDA
Middle Name:LATOYA
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MA, MFT, AMFT, PSYDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3002
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247-1202
Mailing Address - Country:US
Mailing Address - Phone:714-296-6831
Mailing Address - Fax:
Practice Address - Street 1:3360 E IMPERIAL HWY # 220-240
Practice Address - Street 2:
Practice Address - City:LYNWOOD
Practice Address - State:CA
Practice Address - Zip Code:90262-3306
Practice Address - Country:US
Practice Address - Phone:323-769-7174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-16
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA131924106H00000X, 106H00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist