Provider Demographics
NPI:1073651345
Name:CARTER DAVIS, MARTHA (LPC CSAC)
Entity Type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:
Last Name:CARTER DAVIS
Suffix:
Gender:F
Credentials:LPC CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 HULL ST APT 21W
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23224-4288
Mailing Address - Country:US
Mailing Address - Phone:804-310-3982
Mailing Address - Fax:
Practice Address - Street 1:7374 CREIGHTON PKWY
Practice Address - Street 2:EAST HANOVER FAMILY COUNSELING
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23111-4513
Practice Address - Country:US
Practice Address - Phone:804-365-6781
Practice Address - Fax:804-365-6779
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701004064101Y00000X
VA0710102135101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor