Provider Demographics
NPI:1336359124
Name:DAVIS-MARENS, JOY SUZANNE (LCAS)
Entity Type:Individual
Prefix:MRS
First Name:JOY
Middle Name:SUZANNE
Last Name:DAVIS-MARENS
Suffix:
Gender:F
Credentials:LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3473 FORESTDALE DR APT 3B
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-8203
Mailing Address - Country:US
Mailing Address - Phone:336-908-8789
Mailing Address - Fax:
Practice Address - Street 1:3473 FORESTDALE DR APT 3B
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-8203
Practice Address - Country:US
Practice Address - Phone:336-908-8789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC475101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)