Doctor Name: | MRS. MARY JO SARAH DAVIS |
NPI Number: | 1417179144 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | L.C.S.W. |
License Number: | 0904002400 |
Business Practice Address: | 621 W Main St Purcellville, VA - 201323012 |
Business Phone Number: | 7032036542 |
Business Fax Number: | |
Mailing Address: | 309 Breckinridge Ct, BERRYVILLE |
State: | VA |
Postal Code: | 226111405 |
Phone Number: | 5409550667 |
Fax Number: | |
NPI Enumeration Date: | 05/03/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 0904002400 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | VA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |