Provider Demographics
NPI:1629324512
Name:DAVIS, CHRISTIE L (MSW,LCSW)
Entity Type:Individual
Prefix:MS
First Name:CHRISTIE
Middle Name:L
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MSW,LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1830 OWEN DRIVE
Mailing Address - Street 2:SUITE 10-9
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304
Mailing Address - Country:US
Mailing Address - Phone:252-916-9187
Mailing Address - Fax:
Practice Address - Street 1:1830 OWEN DRIVE
Practice Address - Street 2:SUITE 10-9
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304
Practice Address - Country:US
Practice Address - Phone:252-916-9187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-27
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0076331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical