Healthcare Provider Details

I. General information

NPI: 1164141008
Provider Name (Legal Business Name): BRITTANY LOUANN DAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2022
Last Update Date: 08/24/2022
Certification Date: 08/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2004 PROFESSIONAL CT
MARTINSBURG WV
25401-8808
US

IV. Provider business mailing address

2004 PROFESSIONAL CT
MARTINSBURG WV
25401-8808
US

V. Phone/Fax

Practice location:
  • Phone: 304-596-5780
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: