Provider Demographics
NPI:1255768271
Name:MATHIS, DAVENE ANN (LICSW)
Entity type:Individual
Prefix:MS
First Name:DAVENE
Middle Name:ANN
Last Name:MATHIS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2215 PLANK RD # 270
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-5226
Mailing Address - Country:US
Mailing Address - Phone:540-805-0066
Mailing Address - Fax:
Practice Address - Street 1:826 CAROLINE ST STE A
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-5806
Practice Address - Country:US
Practice Address - Phone:202-903-8303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-04
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC500795151041C0700X
VA09040091171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical