| Organization Name: | DR. MIKOL S. DAVIS, CHILD & FAMILY COUNSELING, A PROFESSIONAL CORPORAT |
| NPI Number: | 1033412853 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MIKOL S. DAVIS (PRESIDENT) |
| Mailing Address: | 930 Irwin St Suite 215 San Rafael |
| State: | CA US |
| Postal Code: | 949013340 |
| Phone Number: | 4154591203 |
| Fax Number: | 4154593682 |
| NPI Enumeration Date: | 12/16/2010 |
| NPI Last Update Date: | 01/30/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 00PL90630 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |