Provider Demographics
NPI:1396082368
Name:DAVIS, STEFANIE JANELLE (LMBT)
Entity type:Individual
Prefix:MS
First Name:STEFANIE
Middle Name:JANELLE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8000 CORPORATE CENTER DR
Mailing Address - Street 2:212
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-4464
Mailing Address - Country:US
Mailing Address - Phone:704-441-4941
Mailing Address - Fax:
Practice Address - Street 1:8000 CORPORATE CENTER DR
Practice Address - Street 2:212
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-4464
Practice Address - Country:US
Practice Address - Phone:704-441-4941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-11
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10040174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist