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General NPI Number Information
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NPI Number | 1336298868
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Entity Type | Individual
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Provider Name | MELISSA RICHARDSON DAVIS LCSW, LCAS, MSW
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Gender | Female
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Dates
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Enumeration Date | 01/10/2007
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 14680 US HIGHWAY 17 N
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City | HAMPSTEAD
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State | NC
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Zip | 28443-3504
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Country | US
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Telephone | 910-319-1605
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 308
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City | HAMPSTEAD
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State | NC
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Zip | 28443-0308
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Country | US
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Telephone | 910-319-1605
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Fax | 910-319-0645
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 15514
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | C005396
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | C005396
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License Number State | NC
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