Provider Demographics
NPI:1952805418
Name:DAVIDSON, KRISTA M (LCSW)
Entity Type:Individual
Prefix:MS
First Name:KRISTA
Middle Name:M
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 MARSHALL RD SW
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180-6465
Mailing Address - Country:US
Mailing Address - Phone:703-937-1556
Mailing Address - Fax:703-937-1597
Practice Address - Street 1:730 MARSHALL RD SW
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-6465
Practice Address - Country:US
Practice Address - Phone:703-937-1556
Practice Address - Fax:703-937-1597
Is Sole Proprietor?:No
Enumeration Date:2018-03-20
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA06047381041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool