Provider Demographics
NPI:1063273449
Name:MICHAEL DAVIS PSYD LLC
Entity type:Organization
Organization Name:MICHAEL DAVIS PSYD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:571-358-9245
Mailing Address - Street 1:221 CLYMER AVE
Mailing Address - Street 2:
Mailing Address - City:FRONT ROYAL
Mailing Address - State:VA
Mailing Address - Zip Code:22630-3917
Mailing Address - Country:US
Mailing Address - Phone:571-358-9245
Mailing Address - Fax:
Practice Address - Street 1:316 WARREN AVE
Practice Address - Street 2:
Practice Address - City:FRONT ROYAL
Practice Address - State:VA
Practice Address - Zip Code:22630-4483
Practice Address - Country:US
Practice Address - Phone:571-358-9245
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty