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General NPI Number Information
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NPI Number | 1679091268
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Entity Type | Individual
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Provider Name | SUSAN DAVIS GREGORY LCAS A
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Gender | Female
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Dates
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Enumeration Date | 09/02/2017
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Last Update Date | 07/21/2025
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Provider Practice Location Address
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Address Line | 309 W MILLBROOK RD STE 161
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City | RALEIGH
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State | NC
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Zip | 27609-4261
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Country | US
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Telephone | 919-559-8690
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Fax | 919-882-1277
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Provider Business Mailing Address
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Address Line | 5405 QUAIL CREEK CT APT 104
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City | RALEIGH
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State | NC
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Zip | 27609-5084
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Country | US
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Telephone | 919-210-7728
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 21441
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 22950
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License Number State | NC
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