Provider Demographics
NPI:1609344118
Name:SALEH, DAVINA SOPHIA
Entity type:Individual
Prefix:
First Name:DAVINA
Middle Name:SOPHIA
Last Name:SALEH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12909 CORDARY AVE APT 19
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-9305
Mailing Address - Country:US
Mailing Address - Phone:310-926-7672
Mailing Address - Fax:
Practice Address - Street 1:10780 SANTA MONICA BLVD STE 230
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-7614
Practice Address - Country:US
Practice Address - Phone:213-985-7068
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-02
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA1225241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health