Provider Demographics
NPI:1093586646
Name:DAVIS, DARICE NICOLE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DARICE
Middle Name:NICOLE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:DARICE
Other - Middle Name:NICOLE
Other - Last Name:ETIENNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7639 HULL STREET RD STE 105
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23235-6438
Mailing Address - Country:US
Mailing Address - Phone:804-938-1519
Mailing Address - Fax:
Practice Address - Street 1:7639 HULL STREET RD STE 105
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-6438
Practice Address - Country:US
Practice Address - Phone:804-938-1519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-12
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810008359103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical