Healthcare Provider Details

I. General information

NPI: 1174545578
Provider Name (Legal Business Name): MELANIE KAYE DAVIS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 08/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14014 SULLYFIELD CIR SUITES A AND B
CHANTILLY VA
20151-1689
US

IV. Provider business mailing address

14014 SULLYFIELD CIR SUITES A AND B
CHANTILLY VA
20151-1689
US

V. Phone/Fax

Practice location:
  • Phone: 703-817-9890
  • Fax: 703-817-9860
Mailing address:
  • Phone: 703-817-9890
  • Fax: 703-817-9860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701003790
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: