Provider Demographics
NPI:1699749192
Name:DAVIES, PAMELA (LCSW)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:DAVIES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 239
Mailing Address - Street 2:
Mailing Address - City:FISHERSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22939-0239
Mailing Address - Country:US
Mailing Address - Phone:540-932-4629
Mailing Address - Fax:540-932-5875
Practice Address - Street 1:79 N MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:FISHERSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22939-2344
Practice Address - Country:US
Practice Address - Phone:540-213-2525
Practice Address - Fax:540-213-2555
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904002291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA140307OtherANTHEM BEHAVIORAL
VA2226533OtherFIRST HEALTH
VA8927201OtherVA PREMIER
VA082556OtherOPTIMA HEALTH
VA2041301OtherCIGNA BEHAVIORAL
VA008927201Medicaid
VA2226533OtherFIRST HEALTH
VA082556OtherOPTIMA HEALTH
VA005903A62Medicare ID - Type Unspecified
VA008927201Medicaid