Provider Demographics
NPI:1023144763
Name:DAVIDSON, ELAINE MARY (LVN)
Entity type:Individual
Prefix:MS
First Name:ELAINE
Middle Name:MARY
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 DAWN CIR
Mailing Address - Street 2:
Mailing Address - City:GALT
Mailing Address - State:CA
Mailing Address - Zip Code:95632-2607
Mailing Address - Country:US
Mailing Address - Phone:209-745-9044
Mailing Address - Fax:
Practice Address - Street 1:143 DAWN CIR
Practice Address - Street 2:
Practice Address - City:GALT
Practice Address - State:CA
Practice Address - Zip Code:95632-2607
Practice Address - Country:US
Practice Address - Phone:209-745-9044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN141423101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)