Provider Demographics
NPI:1053978668
Name:DAVIS, JESSICA CATHERINE
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:CATHERINE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:283 CONSTITUTION DR STE 600
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-6760
Mailing Address - Country:US
Mailing Address - Phone:757-982-2604
Mailing Address - Fax:
Practice Address - Street 1:283 CONSTITUTION DR STE 600
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-6760
Practice Address - Country:US
Practice Address - Phone:579-827-2604
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-20
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810007627103TC0700X, 103T00000X
103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical