Provider Demographics
NPI:1851463095
Name:DAVIS, VICTORIA LYNN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:VICTORIA
Middle Name:LYNN
Last Name:DAVIS
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 1:3857 MARTIN WAY E
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-5268
Mailing Address - Country:US
Mailing Address - Phone:360-714-7170
Mailing Address - Fax:
Practice Address - Street 1:4422 6TH AVE SE
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-1020
Practice Address - Country:US
Practice Address - Phone:360-704-7170
Practice Address - Fax:360-412-4982
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW00004074101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8851720Medicare ID - Type UnspecifiedMEDICARE ID NUMBER