Provider Demographics
NPI:1316771835
Name:DAVIS, ROSANNA MARIE (CADC-CAS)
Entity type:Individual
Prefix:
First Name:ROSANNA
Middle Name:MARIE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:CADC-CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3640 S G ST
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93033-6040
Mailing Address - Country:US
Mailing Address - Phone:805-330-7213
Mailing Address - Fax:
Practice Address - Street 1:1164 N A ST
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-4369
Practice Address - Country:US
Practice Address - Phone:805-330-7213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-27
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC052400518101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)