Provider Demographics
NPI:1831489210
Name:DAVIS, SHANISE BLACKMON (MA, NCC, LPC)
Entity Type:Individual
Prefix:MISS
First Name:SHANISE
Middle Name:BLACKMON
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MA, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:339 ESTHER CIR
Mailing Address - Street 2:
Mailing Address - City:KANNAPOLIS
Mailing Address - State:NC
Mailing Address - Zip Code:28083-9026
Mailing Address - Country:US
Mailing Address - Phone:704-298-8926
Mailing Address - Fax:
Practice Address - Street 1:339 ESTHER CIR
Practice Address - Street 2:
Practice Address - City:KANNAPOLIS
Practice Address - State:NC
Practice Address - Zip Code:28083-9026
Practice Address - Country:US
Practice Address - Phone:704-224-3260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-19
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA8739101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional