Provider Demographics
NPI:1245559152
Name:DAVIS, DEBRA LYNNE (PHD)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:LYNNE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2440 M ST NW
Mailing Address - Street 2:SUITE 429
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20037-1404
Mailing Address - Country:US
Mailing Address - Phone:410-530-5216
Mailing Address - Fax:301-345-4530
Practice Address - Street 1:2440 M ST NW
Practice Address - Street 2:SUITE 429
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037-1404
Practice Address - Country:US
Practice Address - Phone:410-530-5216
Practice Address - Fax:301-345-4530
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-18
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04611103T00000X
DCPSY1508103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist