Healthcare Provider Details

I. General information

NPI: 1215820055
Provider Name (Legal Business Name): YANCY DENISE DAVIS D. MIN, CRAADC, LCAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2025
Last Update Date: 09/27/2026
Certification Date: 09/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8601 SIX FORKS RD STE 400
RALEIGH NC
27615-2965
US

IV. Provider business mailing address

3725 FLORA AVE
KANSAS CITY MO
64109-2709
US

V. Phone/Fax

Practice location:
  • Phone: 816-200-1090
  • Fax:
Mailing address:
  • Phone: 816-200-1090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateNC
# 4
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCAS-32066
License Number StateNC
# 5
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number19955
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: