Provider Demographics
NPI:1386003119
Name:PERRY, DAMITA (CSAC, LMHP-R)
Entity Type:Individual
Prefix:MS
First Name:DAMITA
Middle Name:
Last Name:PERRY
Suffix:
Gender:F
Credentials:CSAC, LMHP-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1704 ROSE AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23222-4927
Mailing Address - Country:US
Mailing Address - Phone:804-874-3208
Mailing Address - Fax:
Practice Address - Street 1:1704 ROSE AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23222-4927
Practice Address - Country:US
Practice Address - Phone:804-874-3208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-22
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0710102945101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)