Healthcare Provider Details

I. General information

NPI: 1770611527
Provider Name (Legal Business Name): NIKKIMAH PEARLINE DAVIS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NIKKIMAH PEARLINE AMIN LCSW

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 01/29/2022
Certification Date: 01/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4411 ASHGROVE DR
DUMFRIES VA
22025-1625
US

IV. Provider business mailing address

4411 ASHGROVE DR
DUMFRIES VA
22025-1625
US

V. Phone/Fax

Practice location:
  • Phone: 571-229-7334
  • Fax: 571-285-0029
Mailing address:
  • Phone: 267-664-5641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW126150
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW016406
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberKY-5125
License Number StateKY
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904009333
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: