Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | PSY 17206 | CA |
NPI | 1073719480 |
---|---|
Provider Name | Dr. Claytie Davis III |
First Address | Berkeley, CA 94720-4304 |
Second Address | Berkeley, CA 94720-4304 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2007 |
Last Update Date | 08/07/2007 |