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General NPI Number Information
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NPI Number | 1962879072
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Entity Type | Individual
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Provider Name | DR. KELLY DAVIS
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Gender | Female
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Dates
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Enumeration Date | 08/24/2015
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Last Update Date | 10/09/2024
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Provider Practice Location Address
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Address Line | 1970 ROANOKE BLVD
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City | SALEM
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State | VA
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Zip | 24153-6478
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Country | US
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Telephone | 540-982-2463
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Fax |
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Provider Business Mailing Address
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Address Line | 2601 AVENHAM AVE SW
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City | ROANOKE
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State | VA
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Zip | 24014-1506
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Country | US
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Telephone | 720-837-9659
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 0810008685
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | BBH-LCPC-LIC-37760
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License Number State | MT
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