Provider Demographics
NPI:1962473868
Name:DAVIS, TRENT ALAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:TRENT
Middle Name:ALAN
Last Name:DAVIS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1701 BOXWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24060-1906
Mailing Address - Country:US
Mailing Address - Phone:540-239-1756
Mailing Address - Fax:540-552-4502
Practice Address - Street 1:102 BROCE DR
Practice Address - Street 2:
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-7807
Practice Address - Country:US
Practice Address - Phone:540-239-1756
Practice Address - Fax:540-552-4502
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-30
Last Update Date:2016-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701003905101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional