Provider Demographics
NPI:1619907763
Name:DAVIS, NANCY DAVIS (PHD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:DAVIS
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9836 NATICK RD
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-2931
Mailing Address - Country:US
Mailing Address - Phone:703-472-3886
Mailing Address - Fax:703-978-1130
Practice Address - Street 1:5901 KINGSTOWNE VILLAGE PKWY
Practice Address - Street 2:SUITE 205
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22315-5880
Practice Address - Country:US
Practice Address - Phone:703-472-3886
Practice Address - Fax:703-978-1130
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810003275103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAA-188 0001OtherFEDERAL BLUE CROSS