Provider Demographics
NPI:1316107923
Name:HEARD-DAVISON, AMY RENE (PHD)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:RENE
Last Name:HEARD-DAVISON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:AMY
Other - Middle Name:RENE
Other - Last Name:HEARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:PO BOX 801
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22183-0801
Mailing Address - Country:US
Mailing Address - Phone:703-894-7612
Mailing Address - Fax:
Practice Address - Street 1:8316 ARLINGTON BLVD
Practice Address - Street 2:SUITE 310
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-5207
Practice Address - Country:US
Practice Address - Phone:703-641-0333
Practice Address - Fax:703-573-3316
Is Sole Proprietor?:No
Enumeration Date:2008-06-17
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810003801103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical