Provider Demographics
NPI:1396302444
Name:DAVIDSON, FAYESHON (MS, QMHP-A, QMHP-C)
Entity type:Individual
Prefix:
First Name:FAYESHON
Middle Name:
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:MS, QMHP-A, QMHP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14112 ELKINGTON DR
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23836-5752
Mailing Address - Country:US
Mailing Address - Phone:804-479-1677
Mailing Address - Fax:
Practice Address - Street 1:4318 OLD HUNDRED RD STE C
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23831-4231
Practice Address - Country:US
Practice Address - Phone:804-479-1677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-23
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0732005478101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health