Provider Demographics
NPI:1063640894
Name:DAVIS, CARMEN (PHD, LCMHCS, NCC)
Entity Type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PHD, LCMHCS, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5318 SILCHESTER LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28215-5302
Mailing Address - Country:US
Mailing Address - Phone:360-339-3838
Mailing Address - Fax:
Practice Address - Street 1:1905 J N PEASE PL STE 202
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-4539
Practice Address - Country:US
Practice Address - Phone:360-339-3838
Practice Address - Fax:704-981-9567
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-01
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3527101Y00000X, 101YM0800X, 251B00000X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102558Medicaid