Provider Demographics
NPI:1518037449
Name:DAVIS, VERONICA (LCSW)
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 FULCHER LN
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23836-2714
Mailing Address - Country:US
Mailing Address - Phone:804-530-2013
Mailing Address - Fax:804-530-5159
Practice Address - Street 1:501 FULCHER LN
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23836-2714
Practice Address - Country:US
Practice Address - Phone:804-530-2013
Practice Address - Fax:804-530-5159
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1041C0700X
VA09040036571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA8911258Medicaid