Provider Demographics
NPI:1023730603
Name:DAVIS, WEPTANOMAH CARTER (PHD, LGPC)
Entity type:Individual
Prefix:
First Name:WEPTANOMAH
Middle Name:CARTER
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PHD, LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5001 PATUXENT RIDING LN
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20715-3353
Mailing Address - Country:US
Mailing Address - Phone:301-860-1294
Mailing Address - Fax:
Practice Address - Street 1:1300 MERCANTILE LN STE 208
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-5340
Practice Address - Country:US
Practice Address - Phone:301-583-0001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP6278101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor