Provider Demographics
NPI:1972655140
Name:DAVIS, CAROLYN GWENYTH (MED, EDS)
Entity Type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:GWENYTH
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MED, EDS
Other - Prefix:
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Mailing Address - Street 1:552 WOODGROVE CT
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-2008
Mailing Address - Country:US
Mailing Address - Phone:757-424-9703
Mailing Address - Fax:757-424-9730
Practice Address - Street 1:281 INDEPENDENCE BLVD
Practice Address - Street 2:SUITE 326
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-2986
Practice Address - Country:US
Practice Address - Phone:757-490-0377
Practice Address - Fax:757-497-1327
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0803000143103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool