Healthcare Provider Details

I. General information

NPI: 1568886703
Provider Name (Legal Business Name): SUZANNE OVERSTREET DAVIS LPC, RPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SUZANNE FLORENCE OVERSTREET LPC

II. Dates (important events)

Enumeration Date: 02/07/2014
Last Update Date: 08/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

916 BUTTS STATION RD
CHESAPEAKE VA
23320-3120
US

IV. Provider business mailing address

517 RUBY COURT
CHESAPEAKE VA
23320
US

V. Phone/Fax

Practice location:
  • Phone: 757-615-6476
  • Fax:
Mailing address:
  • Phone: 540-420-0306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701005706
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: