Provider Demographics
NPI:1821348970
Name:DAVIS, ROCHELLE L (LCSW-CP)
Entity Type:Individual
Prefix:
First Name:ROCHELLE
Middle Name:L
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LCSW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 547
Mailing Address - Street 2:
Mailing Address - City:LITTLE RIVER
Mailing Address - State:SC
Mailing Address - Zip Code:29566-0547
Mailing Address - Country:US
Mailing Address - Phone:843-663-8000
Mailing Address - Fax:843-663-8123
Practice Address - Street 1:4220 CAROLINA EXCHANGE DRIVE
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29579-4220
Practice Address - Country:US
Practice Address - Phone:843-663-8000
Practice Address - Fax:843-663-8123
Is Sole Proprietor?:No
Enumeration Date:2012-09-17
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2478C1041C0700X
NV7183-C1041C0700X
SC123991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical