Provider Demographics
NPI:1538943923
Name:DAVIS, MARC PATRICK (MSW, MT-BC)
Entity type:Individual
Prefix:
First Name:MARC
Middle Name:PATRICK
Last Name:DAVIS
Suffix:
Gender:M
Credentials:MSW, MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4225 SUMMIT MANOR CT APT 106
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-5736
Mailing Address - Country:US
Mailing Address - Phone:440-227-6979
Mailing Address - Fax:
Practice Address - Street 1:4225 SUMMIT MANOR CT APT 106
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-5736
Practice Address - Country:US
Practice Address - Phone:440-227-6979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-24
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09060140971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical