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NPI Code Detail

MEDICARE: CHRISTIAN MARSHALL DAVIDSON LCMHC, LCAS

MEDICARE: CHRISTIAN MARSHALL DAVIDSON LCMHC, LCAS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) CounselorLCAS-20004NC
2101YM0800XMental Health Counselor10823NC

General Provider Information

NPI Number : 1164840450
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHRISTIAN MARSHALL DAVIDSON LCMHC, LCAS
Provider Business Mailing Address
First Line : 276 OLD MOCKSVILLE RD STE 100
Second Line :
City : STATESVILLE
State : NC
Zip : 28625-1951
Country : US
Telephone Number : 704-360-3637
Fax Number : 704-200-9829
Provider Business Practice Location Address
First Line : 276 OLD MOCKSVILLE RD STE 100
Second Line :
City : STATESVILLE
State : NC
Zip : 28625-1951
Country : US
Telephone Number : 704-360-3637
Fax Number : 704-200-9829
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/03/2014
Last Update Date : 12/15/2023

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