Provider Demographics
NPI:1184645939
Name:DAMERON, DAVID B (PHD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:B
Last Name:DAMERON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2406
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23804-2406
Mailing Address - Country:US
Mailing Address - Phone:804-760-8232
Mailing Address - Fax:508-433-1871
Practice Address - Street 1:561 HIGH ST
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23803-3859
Practice Address - Country:US
Practice Address - Phone:804-760-8232
Practice Address - Fax:508-433-1871
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810002009103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA191421OtherANTHEM
VA207906000OtherMAGELLAN
VA2198856OtherCIGNA
VA396675OtherVALUE OPTIONS