MEDICARE: KRISTIN N. DAVIS LMFT

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
1	106H00000X	Marriage & Family Therapist	1926	NC

General Provider Information

NPI Number	:	1407244718
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN N. DAVIS LMFT

Provider Business Mailing Address
First Line	:	9635 SOUTHERN PINE BLVD
Second Line	:	STE 101
City	:	CHARLOTTE
State	:	NC
Zip	:	28273-5540
Country	:	US
Telephone Number	:	704-266-0651
Fax Number	:

Provider Business Practice Location Address
First Line	:	9635 SOUTHERN PINE BLVD
Second Line	:	STE 101
City	:	CHARLOTTE
State	:	NC
Zip	:	28273-5540
Country	:	US
Telephone Number	:	704-266-0651
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/08/2015
Last Update Date	:	06/20/2023

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