Provider Demographics
NPI:1568998862
Name:DAVIS, SHERRI (LCSWA)
Entity Type:Individual
Prefix:
First Name:SHERRI
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:635 COX RD STE B
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-3441
Mailing Address - Country:US
Mailing Address - Phone:704-691-7561
Mailing Address - Fax:704-691-7563
Practice Address - Street 1:635 COX RD STE B
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-3441
Practice Address - Country:US
Practice Address - Phone:704-691-7561
Practice Address - Fax:704-691-7563
Is Sole Proprietor?:No
Enumeration Date:2017-05-04
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
NCP0138941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1568998862Medicaid