Provider Demographics
NPI:1932431939
Name:DAVIS, BRENDA C (LCSW)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:C
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:628 E 12TH ST
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27889-3409
Mailing Address - Country:US
Mailing Address - Phone:252-975-8857
Mailing Address - Fax:252-975-8868
Practice Address - Street 1:1379 COWELL FARM RD
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:NC
Practice Address - Zip Code:27889-3495
Practice Address - Country:US
Practice Address - Phone:252-975-8857
Practice Address - Fax:252-975-8868
Is Sole Proprietor?:No
Enumeration Date:2010-02-02
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0063391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical