| Mikol S Davis Child & Family Counseling A Prof Corp | |
|
1703 5th Ave Ste 101 San Rafael CA 94901-1853 | |
| (415) 459-1203 | |
| (415) 459-3682 |
| Full Name | Mikol S Davis Child & Family Counseling A Prof Corp |
|---|---|
| Speciality | Psychologist |
| Location | 1703 5th Ave Ste 101, San Rafael, California |
| Authorized Official Name and Position | Mikol S. Davis (PRESIDENT) |
| Authorized Official Contact | 4154591203 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mikol S Davis Child & Family Counseling A Prof Corp 1703 5th Ave Ste 101 San Rafael CA 94901-1853 Ph: (415) 459-1203 | Mikol S Davis Child & Family Counseling A Prof Corp 1703 5th Ave Ste 101 San Rafael CA 94901-1853 Ph: (415) 459-1203 |
| NPI Number | 1033412853 |
|---|---|
| Provider Enumeration Date | 12/16/2010 |
| Last Update Date | 11/21/2025 |
| Certification Date | 11/21/2025 |
| Medicare PECOS PAC ID | 1557559283 |
|---|---|
| Medicare Enrollment ID | O20101222000732 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033412853 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 00PL90630 (California) | Primary |
| Provider Name | Mikol S Davis |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1073525895 PECOS PAC ID: 0840488573 Enrollment ID: I20101222000856 |
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