Provider Demographics
NPI:1548979065
Name:DAVIS, ALYSON K (LMFT)
Entity type:Individual
Prefix:MRS
First Name:ALYSON
Middle Name:K
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11202 BARNSWALLOW PL APT D
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20603-4832
Mailing Address - Country:US
Mailing Address - Phone:703-209-7976
Mailing Address - Fax:
Practice Address - Street 1:11202 BARNSWALLOW PL APT D
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20603-4832
Practice Address - Country:US
Practice Address - Phone:703-209-7976
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-23
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0717001956106H00000X
MDLCM922106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist