Provider Demographics
NPI:1528424496
Name:DAVIS, AMBER (LGSW)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 GRANT AVE
Mailing Address - Street 2:
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-4234
Mailing Address - Country:US
Mailing Address - Phone:407-470-9169
Mailing Address - Fax:
Practice Address - Street 1:100 M ST SE STE 667
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20003-3519
Practice Address - Country:US
Practice Address - Phone:202-749-8630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-07
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLG50081129104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker