Provider Demographics
NPI:1790083285
Name:DAVIS, HENRI R (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:HENRI
Middle Name:R
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:HENRI
Other - Middle Name:R
Other - Last Name:JORDAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10903 INDIAN HEAD HWY
Mailing Address - Street 2:STE. 503
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20744-4000
Mailing Address - Country:US
Mailing Address - Phone:301-292-3994
Mailing Address - Fax:301-292-4928
Practice Address - Street 1:10903 INDIAN HEAD HWY
Practice Address - Street 2:STE. 503
Practice Address - City:FORT WASHINGTON
Practice Address - State:MD
Practice Address - Zip Code:20744-4000
Practice Address - Country:US
Practice Address - Phone:301-292-3994
Practice Address - Fax:301-292-4928
Is Sole Proprietor?:No
Enumeration Date:2011-03-07
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC3895101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional