Provider Demographics
NPI:1598743338
Name:DAVIS, ZAIDE ANDRE (LCSW)
Entity Type:Individual
Prefix:MR
First Name:ZAIDE
Middle Name:ANDRE
Last Name:DAVIS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:MR
Other - First Name:BRAD
Other - Middle Name:ANDREW
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1914 J N PEASE PL
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-4504
Mailing Address - Country:US
Mailing Address - Phone:704-287-0032
Mailing Address - Fax:704-947-9785
Practice Address - Street 1:1914 J N PEASE PL
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-4504
Practice Address - Country:US
Practice Address - Phone:704-287-0032
Practice Address - Fax:704-947-9785
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-03
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0028711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6002551Medicaid