MEDICARE: HUNTER ELIZABETH DAVIS LCMHCA, LCAS-A

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	LCAS-25238	NC
2	101YM0800X	Mental Health Counselor	A17206	NC

General Provider Information

NPI Number	:	1407315526
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HUNTER ELIZABETH DAVIS LCMHCA, LCAS-A

Provider Business Mailing Address
First Line	:	322 S COLLEGE RD # 1028
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28403-1632
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	322 S COLLEGE RD # 1028
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28403-1632
Country	:	US
Telephone Number	:	919-819-2096
Fax Number	:

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

Provider Enumeration Date	:	03/18/2019
Last Update Date	:	01/24/2023

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