Healthcare Provider Details

I. General information

NPI: 1255535514
Provider Name (Legal Business Name): JAMES RYAN DAVIDSON LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2007
Last Update Date: 06/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2202 EXECUTIVE DR STE C
HAMPTON VA
23666-6604
US

IV. Provider business mailing address

2202 EXECUTIVE DR STE C
HAMPTON VA
23666-6604
US

V. Phone/Fax

Practice location:
  • Phone: 757-827-7707
  • Fax:
Mailing address:
  • Phone: 757-827-7707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6565
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: