Provider Demographics
NPI:1265511596
Name:DAVIDSON, PHILIP G II (LCSW)
Entity Type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:G
Last Name:DAVIDSON
Suffix:II
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:327 W 21ST STREET
Mailing Address - Street 2:SUITE 205
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23517
Mailing Address - Country:US
Mailing Address - Phone:757-622-9852
Mailing Address - Fax:757-622-4033
Practice Address - Street 1:327 W 21ST STREET
Practice Address - Street 2:SUITE 205
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23517
Practice Address - Country:US
Practice Address - Phone:757-622-9852
Practice Address - Fax:757-622-4033
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904000380104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009813T28Medicare ID - Type Unspecified