Healthcare Provider Details

I. General information

NPI: 1720203334
Provider Name (Legal Business Name): DONALD DOUGLAS DAVIS JR. PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 09/11/2024
Certification Date: 09/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 WIND CHIME CT STE B1
RALEIGH NC
27615-6433
US

IV. Provider business mailing address

313 ROSEHAVEN DR
RALEIGH NC
27609-3883
US

V. Phone/Fax

Practice location:
  • Phone: 919-749-4210
  • Fax:
Mailing address:
  • Phone: 919-749-4210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number3222
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3222
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number3222
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number3222
License Number StateNC
# 5
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number3222
License Number StateNC
# 6
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number3222
License Number StateNC
# 7
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number3222
License Number StateNC
# 8
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number3222
License Number StateNC
# 9
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number3222
License Number StateNC
# 10
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number3222
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: