Provider Demographics
NPI:1053199182
Name:DAVIS, MARY BETH (LPCMH)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:BETH
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LPCMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 SILVERSIDE RD STE 67
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19809-1394
Mailing Address - Country:US
Mailing Address - Phone:302-689-3836
Mailing Address - Fax:
Practice Address - Street 1:501 SILVERSIDE RD STE 67
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19809-1394
Practice Address - Country:US
Practice Address - Phone:302-689-3836
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-19
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20853101YM0800X
PAPC-012433101YM0800X
NJ37PC00935900101YM0800X
DEPC-0011181101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health