Healthcare Provider Details

I. General information

NPI: 1780863977
Provider Name (Legal Business Name): ALISON BAKER DAVIS MSW, LCAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2007
Last Update Date: 10/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 E CENTER AVE 2ND FLOOR
MOORESVILLE NC
28115-2578
US

IV. Provider business mailing address

610 E CENTER AVE 2ND FLOOR
MOORESVILLE NC
28115-2578
US

V. Phone/Fax

Practice location:
  • Phone: 704-660-1020
  • Fax: 704-660-1024
Mailing address:
  • Phone: 704-660-1020
  • Fax: 704-660-1024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number717
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: