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General NPI Number Information
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NPI Number | 1598353096
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Entity Type | Individual
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Provider Name | JORDYN NICHOLE DAVIS-POPE LCSW
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Gender | Female
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Dates
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Enumeration Date | 01/10/2021
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Last Update Date | 01/10/2021
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Provider Practice Location Address
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Address Line | 2680 OPITZ BLVD STE 220
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City | WOODBRIDGE
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State | VA
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Zip | 22192-6822
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Country | US
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Telephone | 541-761-2892
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Fax |
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Provider Business Mailing Address
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Address Line | PSC 473 BOX 5273
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City | FPO
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State | AP
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Zip | 96349-0053
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Country | US
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Telephone | 541-761-2892
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 0904012485
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License Number State | VA
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