Provider Demographics
NPI:1164840450
Name:DAVIDSON, CHRISTIAN MARSHALL (LCMHC, LCAS)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:MARSHALL
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:LCMHC, LCAS
Other - Prefix:
Other - First Name:NOEL
Other - Middle Name:
Other - Last Name:DAVIDSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCASA
Mailing Address - Street 1:276 OLD MOCKSVILLE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28625-1951
Mailing Address - Country:US
Mailing Address - Phone:704-360-3637
Mailing Address - Fax:704-200-9829
Practice Address - Street 1:276 OLD MOCKSVILLE RD STE 100
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28625-1951
Practice Address - Country:US
Practice Address - Phone:704-360-3637
Practice Address - Fax:704-200-9829
Is Sole Proprietor?:No
Enumeration Date:2014-04-03
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-20004101YA0400X
NC10823101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)