Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | ||
Y | 103T00000X | Psychologist | ||
N | 103TB0200X | Cognitive & Behavioral Psychologist | ||
N | 103TF0200X | Forensic Psychologist |
NPI | 1013521350 |
---|---|
Provider Name | Davena Limitless Longshore |
First Address | Bakersfield, CA 93313-4327 |
Second Address | Bakersfield, CA 93308-9520 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/09/2020 |
Last Update Date | 09/08/2021 |