Healthcare Provider Details

I. General information

NPI: 1003724162
Provider Name (Legal Business Name): ALICE WADE DAVIS PASTORAL COUNSELOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 QUEENSBERRY CT
GREENSBORO NC
27405-4899
US

IV. Provider business mailing address

134 QUEENSBERRY CT 134 QUEENSBERRY CT
GREENSBORO NC
27405-4899
US

V. Phone/Fax

Practice location:
  • Phone: 919-273-2149
  • Fax: 336-203-3644
Mailing address:
  • Phone: 919-273-2149
  • Fax: 336-203-3644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number2012
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: