Provider Demographics
NPI:1457527673
Name:DAVIS, CAROL ANN (LISW CP)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:ANN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LISW CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 51573
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29649-0043
Mailing Address - Country:US
Mailing Address - Phone:864-396-2810
Mailing Address - Fax:864-396-2810
Practice Address - Street 1:104 MAXWELL AVE
Practice Address - Street 2:SUITE 227
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29646-2641
Practice Address - Country:US
Practice Address - Phone:864-396-2810
Practice Address - Fax:864-396-2810
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-07
Last Update Date:2016-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1309101YA0400X
NCC0061251041C0700X
SC97011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6008307Medicaid
VA10751529OtherCAQH