Individual
CRISTINE DAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
10171 COMERATE RD, GRASS VALLEY, CA 95949-9058
(530) 268-8310
Mailing address
714 W MAIN ST, GRASS VALLEY, CA 95945-6410
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
—
—
Other
Enumeration date
05/01/2007
Last updated
07/08/2007
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