Healthcare Provider Details

I. General information

NPI: 1669808101
Provider Name (Legal Business Name): MELISSA LYNN DAVIS LCMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2013
Last Update Date: 01/02/2024
Certification Date: 01/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 GATEWAY BLVD STE C
MOORESVILLE NC
28117-5544
US

IV. Provider business mailing address

122 GATEWAY BLVD STE C
MOORESVILLE NC
28117-5544
US

V. Phone/Fax

Practice location:
  • Phone: 704-360-3637
  • Fax: 704-200-9829
Mailing address:
  • Phone: 704-360-3637
  • Fax: 704-200-9829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number10179
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number10179
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: