MEDICARE: MS. ALISIA L DAVIS LICSW

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	1041C0700X	Clinical Social Worker	LC303098	DC
2	1041S0200X	School Social Worker	LC303098	DC

General Provider Information

NPI Number	:	1801348685
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ALISIA L DAVIS LICSW

Provider Business Mailing Address
First Line	:	4954 OLYMPIA PL
Second Line	:
City	:	WALDORF
State	:	MD
Zip	:	20602-5105
Country	:	US
Telephone Number	:	760-351-6371
Fax Number	:

Provider Business Practice Location Address
First Line	:	4954 OLYMPIA PL
Second Line	:
City	:	WALDORF
State	:	MD
Zip	:	20602-5105
Country	:	US
Telephone Number	:	760-351-6371
Fax Number	:

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

Provider Enumeration Date	:	10/27/2016
Last Update Date	:	06/26/2024

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