MEDICARE: ALEXANDRIA EDEN DAVIES PHD, LCP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	0810008121	VA

General Provider Information

NPI Number	:	1306525506
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDRIA EDEN DAVIES PHD, LCP

Provider Business Mailing Address
First Line	:	1402 BAINBRIDGE ST UNIT B
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23224-2138
Country	:	US
Telephone Number	:	704-576-9399
Fax Number	:

Provider Business Practice Location Address
First Line	:	1402 BAINBRIDGE ST UNIT B
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23224-2138
Country	:	US
Telephone Number	:	704-576-9399
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2023
Last Update Date	:	07/14/2023

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