Provider Demographics
NPI:1508060005
Name:DAVIS, KAREN R (MA, LPA)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:R
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MA, LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2163 PRESTON TRAILS DR
Mailing Address - Street 2:
Mailing Address - City:WINTERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28590-7047
Mailing Address - Country:US
Mailing Address - Phone:252-349-5838
Mailing Address - Fax:
Practice Address - Street 1:3491 EVANS ST
Practice Address - Street 2:SUITE A
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-4534
Practice Address - Country:US
Practice Address - Phone:252-349-5838
Practice Address - Fax:252-364-2231
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-11
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3395103TC0700X
NCLCAS-A 20839101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)