Provider Demographics
NPI:1083643969
Name:WENDY L DAVIS
Entity Type:Organization
Organization Name:WENDY L DAVIS
Other - Org Name:CAROLINA COUNSELING ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:MS
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:L
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC
Authorized Official - Phone:336-629-4471
Mailing Address - Street 1:1205 N FAYETTEVILLE ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27203-4537
Mailing Address - Country:US
Mailing Address - Phone:336-629-4471
Mailing Address - Fax:336-629-5805
Practice Address - Street 1:1205 N FAYETTEVILLE ST
Practice Address - Street 2:SUITE 102
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203-4537
Practice Address - Country:US
Practice Address - Phone:336-629-4471
Practice Address - Fax:336-629-5805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3057101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6005245Medicaid
NC014M2OtherBLUE CROSS BLUE SHIELD
NCA1291OtherMEDCOST