Provider Demographics
NPI:1174545578
Name:DAVIS, MELANIE KAYE (LPC)
Entity type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:KAYE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14014 SULLYFIELD CIR
Mailing Address - Street 2:SUITES A AND B
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20151-1689
Mailing Address - Country:US
Mailing Address - Phone:703-817-9890
Mailing Address - Fax:703-817-9860
Practice Address - Street 1:14014 SULLYFIELD CIR
Practice Address - Street 2:SUITES A AND B
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20151-1689
Practice Address - Country:US
Practice Address - Phone:703-817-9890
Practice Address - Fax:703-817-9860
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701003790101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA239532OtherANTHEM #/WOODBRIDGE OFFIC
VA7384803OtherANTHEM PROVIDER #
VA239528OtherANTHEM #/CHANTILLY OFFICE