Provider Demographics
NPI:1265110225
Name:DAVIS, KATELYN VIRGINIA (LSW)
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:VIRGINIA
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:KATELYN
Other - Middle Name:VIRGINIA
Other - Last Name:CUTLIP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1095 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:WV
Mailing Address - Zip Code:25541-0015
Mailing Address - Country:US
Mailing Address - Phone:304-807-2655
Mailing Address - Fax:
Practice Address - Street 1:1095 MAIN ST
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:WV
Practice Address - Zip Code:25541-0015
Practice Address - Country:US
Practice Address - Phone:304-807-2655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVSW022316515104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker