Provider Demographics
NPI:1932672268
Name:DAVIS, CATHERINE ASENETH (LCSW-C)
Entity Type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:ASENETH
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4015 LELIA LN
Mailing Address - Street 2:
Mailing Address - City:PORT REPUBLIC
Mailing Address - State:MD
Mailing Address - Zip Code:20676-3108
Mailing Address - Country:US
Mailing Address - Phone:410-474-0103
Mailing Address - Fax:
Practice Address - Street 1:1305 DARES BEACH RD
Practice Address - Street 2:
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678-4208
Practice Address - Country:US
Practice Address - Phone:443-550-9917
Practice Address - Fax:410-286-4038
Is Sole Proprietor?:No
Enumeration Date:2019-01-09
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD113991041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool