Healthcare Provider Details

I. General information

NPI: 1699862557
Provider Name (Legal Business Name): CHRISTINE R DAVIS LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 05/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 SOLAREX CT
FREDERICK MD
21703-7005
US

IV. Provider business mailing address

604 SOLAREX CT
FREDERICK MD
21703-7005
US

V. Phone/Fax

Practice location:
  • Phone: 301-663-8263
  • Fax: 301-682-5326
Mailing address:
  • Phone: 301-663-8263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLC3441
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE0002268
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: