Provider Demographics
NPI:1174959969
Name:DAVIS, TRINA BERNNADETTE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:TRINA
Middle Name:BERNNADETTE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:TRINA
Other - Middle Name:B
Other - Last Name:DAVIS-FORTUNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:755 SAINT ANDREWS DRIVE
Mailing Address - Street 2:APT 14-101
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37128
Mailing Address - Country:US
Mailing Address - Phone:804-901-6928
Mailing Address - Fax:804-414-7733
Practice Address - Street 1:2314 4TH AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23222-4708
Practice Address - Country:US
Practice Address - Phone:804-901-6928
Practice Address - Fax:804-414-7733
Is Sole Proprietor?:No
Enumeration Date:2013-09-24
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16-7031041C0700X
TN66021041C0700X
FLTPSW14351041C0700X
VA09040082811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical