MEDICARE: KIMBERLY MARABLE DAVIS

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	101YM0800X	Mental Health Counselor	12551	NC
2	101YM0800X	Mental Health Counselor	9436	SC

General Provider Information

NPI Number	:	1578013405
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY MARABLE DAVIS

Provider Business Mailing Address
First Line	:	4900 OHEAR AVE STE 100-9033
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29405-5081
Country	:	US
Telephone Number	:	843-410-9809
Fax Number	:	843-310-5578

Provider Business Practice Location Address
First Line	:	4900 OHEAR AVE STE 100-9033
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29405-5081
Country	:	US
Telephone Number	:	843-410-9809
Fax Number	:	843-310-5578

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

Provider Enumeration Date	:	10/04/2016
Last Update Date	:	01/24/2026

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Directions to “ KIMBERLY MARABLE DAVIS ” Practice Location

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