Provider Demographics
NPI:1053566471
Name:EMBREE-DAVIS, SUSAN MARGARET (MA, MFT)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:MARGARET
Last Name:EMBREE-DAVIS
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:SUE
Other - Middle Name:
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MFT
Mailing Address - Street 1:401 STINSON ST APT 4
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94591-6416
Mailing Address - Country:US
Mailing Address - Phone:707-704-1455
Mailing Address - Fax:707-643-0115
Practice Address - Street 1:631 TENNESSEE ST
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94590-4432
Practice Address - Country:US
Practice Address - Phone:707-704-1455
Practice Address - Fax:707-643-0115
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-26
Last Update Date:2008-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36729106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist