Provider Demographics
NPI:1265230734
Name:DAVIS, JESSICA FORYS (LCMHC, LCAS-A)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:FORYS
Last Name:DAVIS
Suffix:
Gender:
Credentials:LCMHC, LCAS-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 NATURE DR APT 2G
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-6989
Mailing Address - Country:US
Mailing Address - Phone:631-786-4392
Mailing Address - Fax:
Practice Address - Street 1:1200 NATURE DR APT 2G
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-6989
Practice Address - Country:US
Practice Address - Phone:631-786-4392
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-03
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-28779101YA0400X
NC18287101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)