Provider Demographics
NPI:1093339566
Name:DAVIS, WILLOUGH (MED)
Entity Type:Individual
Prefix:
First Name:WILLOUGH
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16507 NORTHCROSS DR STE F
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-5082
Mailing Address - Country:US
Mailing Address - Phone:678-634-2280
Mailing Address - Fax:
Practice Address - Street 1:16507 NORTHCROSS DR STE F
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-5082
Practice Address - Country:US
Practice Address - Phone:678-634-2280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-01
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA16145101YP2500X
NCLCAS-26593101YA0400X
NC101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health