Provider Demographics
NPI:1528537271
Name:DAVIS, JAMICIA LANECE (LCSW)
Entity Type:Individual
Prefix:
First Name:JAMICIA
Middle Name:LANECE
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 1:1706 TODDS LN # 275
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-3123
Mailing Address - Country:US
Mailing Address - Phone:757-964-9543
Mailing Address - Fax:757-964-9567
Practice Address - Street 1:1706 TODDS LN
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-3123
Practice Address - Country:US
Practice Address - Phone:757-964-9543
Practice Address - Fax:757-964-9567
Is Sole Proprietor?:No
Enumeration Date:2018-11-23
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040083221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical