Provider Demographics
NPI:1982939468
Name:DAVIS, LORETTA H (LPC, LCAS)
Entity Type:Individual
Prefix:
First Name:LORETTA
Middle Name:H
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LPC, LCAS
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC, LCAS
Mailing Address - Street 1:1000 N 1ST ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ALBEMARLE
Mailing Address - State:NC
Mailing Address - Zip Code:28001-2833
Mailing Address - Country:US
Mailing Address - Phone:704-983-2117
Mailing Address - Fax:704-983-2636
Practice Address - Street 1:284 EXECUTIVE PARK DR
Practice Address - Street 2:STE 100
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-1831
Practice Address - Country:US
Practice Address - Phone:704-939-1100
Practice Address - Fax:704-939-1173
Is Sole Proprietor?:No
Enumeration Date:2009-10-16
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7577101YP2500X
NC1525101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1982939468OtherBCBS
NC1982939468OtherMAGELLAN
NC1982939468OtherUNITED BEHAVIORAL HEALTH
NC1982939468OtherHUMANA
NC1982939468OtherUNITED HEALTHCARE
NC1982939468Medicaid
NC1982939468OtherOPTUM