Provider Demographics
NPI:1437351673
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:INDIVIDUAL/SOLE PROPRIETOR
Authorized Official - Prefix:MS
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-629-4471
Mailing Address - Street 1:649 WOODLAND CIR
Mailing Address - Street 2:
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27203-4583
Mailing Address - Country:US
Mailing Address - Phone:336-629-4471
Mailing Address - Fax:
Practice Address - Street 1:1205 N FAYETTEVILLE ST
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203-4595
Practice Address - Country:US
Practice Address - Phone:336-629-4471
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-01
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC937101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty