Provider Demographics
NPI:1598353096
Name:DAVIS-POPE, JORDYN NICHOLE (LCSW)
Entity Type:Individual
Prefix:
First Name:JORDYN
Middle Name:NICHOLE
Last Name:DAVIS-POPE
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:PSC 473 BOX 5273
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96349-0053
Mailing Address - Country:US
Mailing Address - Phone:541-761-2892
Mailing Address - Fax:
Practice Address - Street 1:2680 OPITZ BLVD STE 220
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-6822
Practice Address - Country:US
Practice Address - Phone:541-761-2892
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-10
Last Update Date:2021-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904012485101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health