Provider Demographics
NPI:1639875875
Name:DAVIS, TRINA
Entity Type:Individual
Prefix:
First Name:TRINA
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9413 HULL STREET RD STE A1
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23236-1246
Mailing Address - Country:US
Mailing Address - Phone:804-322-7795
Mailing Address - Fax:
Practice Address - Street 1:9413 HULL STREET RD STE A1
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23236-1246
Practice Address - Country:US
Practice Address - Phone:804-322-7795
Practice Address - Fax:804-773-4449
Is Sole Proprietor?:No
Enumeration Date:2023-01-31
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6676Other6676-LICRSENSE NUMBER