Provider Demographics
NPI:1306015391
Name:DAVIDSON, VANESSA L (PSYD)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:L
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:975 KINGSVIEW DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45036-9562
Mailing Address - Country:US
Mailing Address - Phone:513-228-7854
Mailing Address - Fax:513-228-7848
Practice Address - Street 1:201 READING RD
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-1666
Practice Address - Country:US
Practice Address - Phone:513-398-2551
Practice Address - Fax:513-459-7300
Is Sole Proprietor?:No
Enumeration Date:2008-02-25
Last Update Date:2013-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH7096103TC0700X
IL071.008359103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical