Provider Demographics
NPI:1225762461
Name:DAVILA, STEPHANIE BARRETT (PMHNP)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:BARRETT
Last Name:DAVILA
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:BARRETT
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:6857 JOCKEY CLUB LN
Mailing Address - Street 2:
Mailing Address - City:HAYMARKET
Mailing Address - State:VA
Mailing Address - Zip Code:20169-2979
Mailing Address - Country:US
Mailing Address - Phone:703-932-9964
Mailing Address - Fax:
Practice Address - Street 1:2241M TACKETTS MILL DR
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-3029
Practice Address - Country:US
Practice Address - Phone:571-777-0970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-13
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024184944363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health