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General NPI Number Information
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NPI Number | 1770611527
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Entity Type | Individual
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Provider Name | NIKKIMAH PEARLINE DAVIS LCSW
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Gender | Female
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Dates
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Enumeration Date | 03/02/2007
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Last Update Date | 01/29/2022
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Provider Practice Location Address
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Address Line | 4411 ASHGROVE DR
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City | DUMFRIES
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State | VA
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Zip | 22025-1625
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Country | US
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Telephone | 571-229-7334
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Fax | 571-285-0029
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Provider Business Mailing Address
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Address Line | 4411 ASHGROVE DR
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City | DUMFRIES
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State | VA
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Zip | 22025-1625
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Country | US
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Telephone | 267-664-5641
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | SW126150
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CW016406
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 1041S0200X
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Taxonomy Name | School Social Worker
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License Number | KY-5125
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License Number State | KY
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0904009333
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License Number State | VA
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