Provider Demographics
NPI:1548554181
Name:DAVIS, LOUISE EILEEN (MAC, DIPLAC, LAC)
Entity type:Individual
Prefix:
First Name:LOUISE
Middle Name:EILEEN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MAC, DIPLAC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9501 NEUSE WAY
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:VA
Mailing Address - Zip Code:22066-3810
Mailing Address - Country:US
Mailing Address - Phone:703-380-2084
Mailing Address - Fax:
Practice Address - Street 1:13455 SUNRISE VALLEY DR
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20171-3295
Practice Address - Country:US
Practice Address - Phone:703-380-2084
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-31
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0121000625171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist