Provider Demographics
NPI:1447502851
Name:DAVIS, BETTY ANN (LPC, NCC)
Entity type:Individual
Prefix:MS
First Name:BETTY
Middle Name:ANN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 W 21ST ST
Mailing Address - Street 2:#204
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23517-2246
Mailing Address - Country:US
Mailing Address - Phone:757-567-2511
Mailing Address - Fax:
Practice Address - Street 1:117 W 21ST ST
Practice Address - Street 2:#204
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23517-2246
Practice Address - Country:US
Practice Address - Phone:757-567-2511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-09
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701005323101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional