Basic Information
| Provider Information | |||||||||
| NPI: | 1336418961 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DAVIS | ||||||||
| FirstName: | MELISSA | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | MA, LCMHCQS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2305 EXECUTIVE CIR STE 100 | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278343749 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9089108994 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1202 E FIRE TOWER RD | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278584196 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2523218080 | ||||||||
| FaxNumber: | 2523217999 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/28/2011 | ||||||||
| LastUpdateDate: | 04/22/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/22/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | A10180 | NC | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YM0800X | 10180 | NC | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YA0400X | NC | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.