Active NPI
Shane Davis
- Professional Counselor
- Fredericksburg, VA
National Provider Identifier
1164071379
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 0701008416
- Practice address
- 4532 Plank Rd
Fredericksburg, VA 22407-0139 - Phone
- (804) 230-0999
- NPI assigned
- Sep 10, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 0701008416 | VA | Primary |
Addresses
Primary practice location
4532 Plank Rd
Fredericksburg, VA 22407-0139
Mailing address
4532 Plank Rd
Fredericksburg, VA 22407-0139
Phone (301) 789-9458
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0701008416 | VA | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Accent Group and Family Services, LLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Community/Behavioral Health Agency
- North Chesterfield, VA
- NPI 1780950493
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1568073600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1570060800000",
"number": "1164071379",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4532 PLANK RD",
"city": "FREDERICKSBURG",
"state": "VA",
"postal_code": "224070139",
"telephone_number": "301-789-9458"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4532 PLANK RD",
"city": "FREDERICKSBURG",
"state": "VA",
"postal_code": "224070139",
"telephone_number": "804-230-0999"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIS",
"first_name": "SHANE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-09-10",
"last_updated": "2019-10-03",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "VA",
"license": "0701008416",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "Email",
"affiliation": "N",
"address_1": "4532 Plank Rd",
"city": "Fredericksburg",
"state": "VA",
"country_code": "US",
"postal_code": "224070139",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Fredericksburg, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.