MEDICARE: DONNA M DAVIS LCSW, LMFT, CSAT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	215	NC
2	106H00000X	Marriage & Family Therapist	392	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	27532	OTHER	NC	BLUE CROSS PIN

General Provider Information

NPI Number	:	1023234218
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONNA M DAVIS LCSW, LMFT, CSAT

Provider Business Mailing Address
First Line	:	5950 FAIRVIEW RD STE 603
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28210-3113
Country	:	US
Telephone Number	:	704-333-3341
Fax Number	:

Provider Business Practice Location Address
First Line	:	5950 FAIRVIEW RD STE 603
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28210-3113
Country	:	US
Telephone Number	:	704-333-3341
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/17/2007
Last Update Date	:	01/22/2019

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