Provider Demographics
NPI:1861534901
Name:DAVIS, RACHEL MARIE (MFT)
Entity type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:MARIE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:780 SHADOWRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92083-7986
Mailing Address - Country:US
Mailing Address - Phone:619-888-8661
Mailing Address - Fax:760-599-2399
Practice Address - Street 1:780 SHADOWRIDGE DR
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92083-7986
Practice Address - Country:US
Practice Address - Phone:619-888-8661
Practice Address - Fax:760-599-2399
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44991106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA8857OtherUBH