Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003311408 |
---|---|
Provider Name | Melanie Davenport |
First Address | San Leandro, CA 94578-1132 |
Second Address | San Leandro, CA 94578-1132 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2018 |
Last Update Date | 27/03/2018 |