Provider Demographics
NPI:1013305747
Name:DAVIS, CASEY LEANN (PSYD, LCP)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:LEANN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PSYD, LCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43130 AMBERWOOD PLZ
Mailing Address - Street 2:SUITE 140
Mailing Address - City:SOUTH RIDING
Mailing Address - State:VA
Mailing Address - Zip Code:20152-4105
Mailing Address - Country:US
Mailing Address - Phone:703-348-0030
Mailing Address - Fax:
Practice Address - Street 1:43130 AMBERWOOD PLZ
Practice Address - Street 2:SUITE 140
Practice Address - City:SOUTH RIDING
Practice Address - State:VA
Practice Address - Zip Code:20152-4105
Practice Address - Country:US
Practice Address - Phone:703-348-0030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-05
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810005138103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical