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General NPI Number Information
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NPI Number | 1235016478
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Entity Type | Individual
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Provider Name | BROOK DAVIS
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Gender |
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Dates
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Enumeration Date | 08/19/2025
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Last Update Date | 08/19/2025
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Provider Practice Location Address
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Address Line | 280 PINEHURST AVE
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City | SOUTHERN PINES
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State | NC
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Zip | 28387-6350
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Country | US
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Telephone | 704-440-3580
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Fax |
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Provider Business Mailing Address
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Address Line | 65 BIRD SONG LN
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City | PARKTON
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State | NC
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Zip | 28371-9477
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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