Healthcare Provider Details

I. General information

NPI: 1184458010
Provider Name (Legal Business Name): MOLLY ALYSSA DAVIS MSW, LCSW-A, LCAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2024
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 CARBONTON RD
SANFORD NC
27330-4009
US

IV. Provider business mailing address

130 CARBONTON RD
SANFORD NC
27330-4009
US

V. Phone/Fax

Practice location:
  • Phone: 980-565-8476
  • Fax:
Mailing address:
  • Phone: 980-565-8478
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP020752
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number29918
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: