Provider Demographics
NPI:1790860559
Name:DAVIS, STACIE (LPC)
Entity type:Individual
Prefix:MRS
First Name:STACIE
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:STACIE
Other - Middle Name:
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:289 INDEPENDENCE BLVD
Mailing Address - Street 2:SUITE 245
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-5493
Mailing Address - Country:US
Mailing Address - Phone:757-385-0850
Mailing Address - Fax:757-518-9713
Practice Address - Street 1:289 INDEPENDENCE BLVD
Practice Address - Street 2:SUITE 245
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-5493
Practice Address - Country:US
Practice Address - Phone:757-385-0850
Practice Address - Fax:757-518-9713
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701003776101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor