Provider Demographics
NPI:1154030385
Name:DAVIS, JENNIFER SMITH (LCSW)
Entity type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:SMITH
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1805 MONUMENT AVE APT 601
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23220-2822
Mailing Address - Country:US
Mailing Address - Phone:609-651-3678
Mailing Address - Fax:
Practice Address - Street 1:8500 EXECUTIVE PARK AVE STE 202
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-2253
Practice Address - Country:US
Practice Address - Phone:703-852-7020
Practice Address - Fax:703-289-4612
Is Sole Proprietor?:No
Enumeration Date:2022-11-16
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040143031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical