Provider Demographics
NPI:1528825726
Name:DAVISON, REINA (PHD, LCSW, LISW)
Entity type:Individual
Prefix:DR
First Name:REINA
Middle Name:
Last Name:DAVISON
Suffix:
Gender:F
Credentials:PHD, LCSW, LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4235 CAMDEN HWY UNIT 4
Mailing Address - Street 2:
Mailing Address - City:DALZELL
Mailing Address - State:SC
Mailing Address - Zip Code:29040-2000
Mailing Address - Country:US
Mailing Address - Phone:703-474-2877
Mailing Address - Fax:
Practice Address - Street 1:US AIR FORCE MEDICAL GROUP 431 MEADOWLARK STREET
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29152
Practice Address - Country:US
Practice Address - Phone:803-895-4222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC163361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical