Healthcare Provider Details

I. General information

NPI: 1427105147
Provider Name (Legal Business Name): FAITH SHAMA DAVIS LICSW, LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 04/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 MARTIN LUTHER KING JR AVE SE
WASHINGTON DC
20032-1542
US

IV. Provider business mailing address

11105 CHERRYVALE TER
BELTSVILLE MD
20705-3847
US

V. Phone/Fax

Practice location:
  • Phone: 202-279-4900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC50078788
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number15867
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: