1376781849 NPI number — MATTIE B DAVIS BA, MA, DD, LPC

NPI Number: 1376781849
Health Care Provider/Practitioner: MATTIE B DAVIS BA, MA, DD, LPC

NPI Number : 1376781849 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1376781849",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "DAVIS",
    "FirstName": "MATTIE",
    "MiddleName": "B",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "BA, MA, DD, LPC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "DAVIS",
    "OtherFirstName": "MATTIE",
    "OtherMiddleName": "BROWN",
    "OtherNamePrefix": "DR.",
    "OtherNameSuffix": null,
    "OtherCredential": "BA, MA, DD, LPC",
    "OtherLastNameTypeCode": "2",
    "FirstLineMailingAddress": "301 MAYCOX AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "NORFOLK",
    "MailingAddressStateName": "VA",
    "MailingAddressPostalCode": "23505-3420",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "757-386-8578",
    "MailingAddressFaxNumber": "757-277-0181",
    "FirstLinePracticeLocationAddress": "301 MAYCOX AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "NORFOLK",
    "PracticeLocationAddressStateName": "VA",
    "PracticeLocationAddressPostalCode": "23505-3420",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "757-386-8578",
    "PracticeLocationAddressFaxNumber": "757-277-0181",
    "EnumerationDate": "01/21/2009",
    "LastUpdateDate": "02/04/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "101YP2500X",
        "TaxonomyName": "Professional Counselor",
        "LicenseNumber": "0701004335",
        "LicenseNumberStateCode": "VA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}