Provider Demographics
NPI:1336298868
Name:DAVIS, MELISSA RICHARDSON (LCSW, LCAS, MSW)
Entity Type:Individual
Prefix:MISS
First Name:MELISSA
Middle Name:RICHARDSON
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LCSW, LCAS, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 308
Mailing Address - Street 2:
Mailing Address - City:HAMPSTEAD
Mailing Address - State:NC
Mailing Address - Zip Code:28443-0308
Mailing Address - Country:US
Mailing Address - Phone:910-319-1605
Mailing Address - Fax:910-319-0645
Practice Address - Street 1:14680 US HIGHWAY 17 N
Practice Address - Street 2:
Practice Address - City:HAMPSTEAD
Practice Address - State:NC
Practice Address - Zip Code:28443-3504
Practice Address - Country:US
Practice Address - Phone:910-319-1605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15514101YA0400X
NCC005396101YP2500X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6106732Medicaid