Healthcare Provider Details

I. General information

NPI: 1962279562
Provider Name (Legal Business Name): AMBER L. DAVIS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2023
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 GRANT AVE
PHILADELPHIA PA
19114-1032
US

IV. Provider business mailing address

2801 GRANT AVE
PHILADELPHIA PA
19114-1032
US

V. Phone/Fax

Practice location:
  • Phone: 215-878-3400
  • Fax: 267-878-2082
Mailing address:
  • Phone: 215-878-3400
  • Fax: 267-878-2082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPC-0011584
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC016517
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: