Provider Demographics
NPI:1083241681
Name:DAVIS, NICOLE LEE (LCMHC, LCAS, CSI)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:LEE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LCMHC, LCAS, CSI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1758 E 11TH ST STE E
Mailing Address - Street 2:
Mailing Address - City:SILER CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27344-2845
Mailing Address - Country:US
Mailing Address - Phone:919-663-3303
Mailing Address - Fax:919-663-3305
Practice Address - Street 1:1758 E 11TH ST
Practice Address - Street 2:
Practice Address - City:SILER CITY
Practice Address - State:NC
Practice Address - Zip Code:27344-2845
Practice Address - Country:US
Practice Address - Phone:919-663-3303
Practice Address - Fax:919-663-3305
Is Sole Proprietor?:No
Enumeration Date:2020-03-24
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-26332101YA0400X
NCA15744101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health