Provider Demographics
NPI:1568150464
Name:DAVIS, JULIE CANNIFFE (LCAS, CSAC, CADC II)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:CANNIFFE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LCAS, CSAC, CADC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3047 JEANNIE ANNA CT
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20171-4071
Mailing Address - Country:US
Mailing Address - Phone:215-266-9517
Mailing Address - Fax:
Practice Address - Street 1:3047 JEANNIE ANNA CT
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20171-4071
Practice Address - Country:US
Practice Address - Phone:215-266-9517
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-27
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA710103757101YA0400X
NCLCAS-28910101YA0400X
VA1198101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)