Provider Demographics
NPI:1689891434
Name:DAVIS, MISTY (M S)
Entity Type:Individual
Prefix:
First Name:MISTY
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:M S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4425 KILLIAM CT
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-6486
Mailing Address - Country:US
Mailing Address - Phone:804-527-5206
Mailing Address - Fax:
Practice Address - Street 1:8110 VIRGINIA PINE CT
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23237-2203
Practice Address - Country:US
Practice Address - Phone:804-743-0727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional