Provider Demographics
NPI:1770611527
Name:DAVIS, NIKKIMAH PEARLINE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:NIKKIMAH
Middle Name:PEARLINE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:NIKKIMAH
Other - Middle Name:PEARLINE
Other - Last Name:AMIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:4411 ASHGROVE DR
Mailing Address - Street 2:
Mailing Address - City:DUMFRIES
Mailing Address - State:VA
Mailing Address - Zip Code:22025-1625
Mailing Address - Country:US
Mailing Address - Phone:267-664-5641
Mailing Address - Fax:
Practice Address - Street 1:4411 ASHGROVE DR
Practice Address - Street 2:
Practice Address - City:DUMFRIES
Practice Address - State:VA
Practice Address - Zip Code:22025-1625
Practice Address - Country:US
Practice Address - Phone:571-229-7334
Practice Address - Fax:571-285-0029
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2022-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW126150104100000X
PACW0164061041C0700X
KYKY-51251041S0200X
VA09040093331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool