Individual
DAVIS LO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
401 S ST, SACRAMENTO, CA 95811-6919
(916) 584-7800
Mailing address
5413 ELFRIEDE WAY, SACRAMENTO, CA 95823-3835
(916) 494-3080
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YM0800X
Mental Health Counselor
90005
CA
104100000X
Social Worker
Primary
90005
CA
1041C0700X
Clinical Social Worker
108134
CA
1041S0200X
School Social Worker
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
93650005A
—
CA
Enumeration date
09/01/2016
Last updated
01/05/2023
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