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NPI Code Detail

MEDICARE: AMANDA DAVIS

MEDICARE: AMANDA DAVIS
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
1101YP2500XProfessional Counselor15541NC

General Provider Information

NPI Number : 1316528326
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA DAVIS
Provider Business Mailing Address
First Line : 1732 CHADWICK SHORES DR
Second Line :
City : SNEADS FERRY
State : NC
Zip : 28460-9282
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3886 HENDERSON DR
Second Line :
City : JACKSONVILLE
State : NC
Zip : 28546-5219
Country : US
Telephone Number : 910-938-9833
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/20/2021
Last Update Date : 12/09/2025

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