Provider Demographics
NPI:1225431463
Name:DAVIS, ROZETTA
Entity Type:Individual
Prefix:
First Name:ROZETTA
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 GROVEMONT DRIVE
Mailing Address - Street 2:APT H4
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-8494
Mailing Address - Country:US
Mailing Address - Phone:252-974-3135
Mailing Address - Fax:
Practice Address - Street 1:2313 EXECUTIVE CIRCLE
Practice Address - Street 2:SUITE C
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-8494
Practice Address - Country:US
Practice Address - Phone:252-215-5700
Practice Address - Fax:252-215-5701
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-02
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC101YM0800XMedicaid