Healthcare Provider Details

I. General information

NPI: 1205731353
Provider Name (Legal Business Name): CHRISTAL DAVIS-RUSSELL MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3705 CREEK POINTE WAY
GREENSBORO NC
27407-5480
US

IV. Provider business mailing address

9 CHESAPEAKE PLZ
CHESAPEAKE OH
45619-1003
US

V. Phone/Fax

Practice location:
  • Phone: 910-885-2652
  • Fax:
Mailing address:
  • Phone: 919-704-8449
  • Fax: 919-704-8617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP018787
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: