Provider Demographics
NPI:1043385925
Name:DAVIS, DONALD A (PHD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:A
Last Name:DAVIS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 RITCHIE HWY
Mailing Address - Street 2:SUITE 207
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146-3916
Mailing Address - Country:US
Mailing Address - Phone:410-315-9350
Mailing Address - Fax:410-315-9353
Practice Address - Street 1:650 RITCHIE HWY
Practice Address - Street 2:SUITE 207
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146-3916
Practice Address - Country:US
Practice Address - Phone:410-315-9350
Practice Address - Fax:410-315-9353
Is Sole Proprietor?:No
Enumeration Date:2006-11-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03185103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist