Provider Demographics
NPI:1134933732
Name:DAVIDSON, SHANIC LAURELL (ASW)
Entity type:Individual
Prefix:
First Name:SHANIC
Middle Name:LAURELL
Last Name:DAVIDSON
Suffix:
Gender:U
Credentials:ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6061
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93703-6061
Mailing Address - Country:US
Mailing Address - Phone:916-759-1293
Mailing Address - Fax:
Practice Address - Street 1:5445 LAUREL HILLS DR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95841-3105
Practice Address - Country:US
Practice Address - Phone:916-710-5890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-04
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW1281471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical