Provider Demographics
NPI:1376781849
Name:DAVIS, MATTIE B (BA, MA, DD, LPC)
Entity type:Individual
Prefix:DR
First Name:MATTIE
Middle Name:B
Last Name:DAVIS
Suffix:
Gender:F
Credentials:BA, MA, DD, LPC
Other - Prefix:DR
Other - First Name:MATTIE
Other - Middle Name:BROWN
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BA, MA, DD, LPC
Mailing Address - Street 1:301 MAYCOX AVE
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23505-3420
Mailing Address - Country:US
Mailing Address - Phone:757-386-8578
Mailing Address - Fax:757-277-0181
Practice Address - Street 1:301 MAYCOX AVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23505-3420
Practice Address - Country:US
Practice Address - Phone:757-386-8578
Practice Address - Fax:757-277-0181
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-21
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701004335101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional