Provider Demographics
NPI:1720407406
Name:DAVIS, NAOMI HOUGH (LPC)
Entity Type:Individual
Prefix:DR
First Name:NAOMI
Middle Name:HOUGH
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6124 WATERMAN PL
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23832-9232
Mailing Address - Country:US
Mailing Address - Phone:804-350-8825
Mailing Address - Fax:804-714-0404
Practice Address - Street 1:823 N 31ST ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23223-6723
Practice Address - Country:US
Practice Address - Phone:804-226-0150
Practice Address - Fax:804-236-1068
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-10
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
0701005742172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0701005742OtherLPC
VA90870OtherNCC