Provider Demographics
NPI:1265594774
Name:DAVIS, CAROLYNNE C (LCDP)
Entity type:Individual
Prefix:MS
First Name:CAROLYNNE
Middle Name:C
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LCDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 PAWTUCKET AVE
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-3811
Mailing Address - Country:US
Mailing Address - Phone:401-722-4644
Mailing Address - Fax:401-475-9533
Practice Address - Street 1:166 PAWTUCKET AVE
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-3811
Practice Address - Country:US
Practice Address - Phone:401-722-4644
Practice Address - Fax:401-475-9533
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILCDP 00180101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)