Healthcare Provider Details

I. General information

NPI: 1386277721
Provider Name (Legal Business Name): THE MORRIS DAVIS FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2020
Last Update Date: 02/13/2020
Certification Date: 02/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1145 COMMERCE AVE
CHESAPEAKE VA
23324-3305
US

IV. Provider business mailing address

PO BOX 5032
CHESAPEAKE VA
23324-0032
US

V. Phone/Fax

Practice location:
  • Phone: 757-790-7906
  • Fax:
Mailing address:
  • Phone: 757-790-7906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number State

VIII. Authorized Official

Name: CYNTHIA Y DUPREE
Title or Position: OWNER/MANAGER
Credential:
Phone: 757-790-7906