Provider Demographics
NPI:1477810570
Name:DAVIS, COURTNAY HEAVNER (LPC)
Entity Type:Individual
Prefix:
First Name:COURTNAY
Middle Name:HEAVNER
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 MONTGOMERY AVE
Mailing Address - Street 2:
Mailing Address - City:STAUNTON
Mailing Address - State:VA
Mailing Address - Zip Code:24401-3968
Mailing Address - Country:US
Mailing Address - Phone:540-213-0450
Mailing Address - Fax:540-213-0456
Practice Address - Street 1:1110 MONTGOMERY AVE
Practice Address - Street 2:
Practice Address - City:STAUNTON
Practice Address - State:VA
Practice Address - Zip Code:24401-3968
Practice Address - Country:US
Practice Address - Phone:540-213-0450
Practice Address - Fax:540-213-0456
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-13
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701005120322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children