MEDICARE: MRS. CHINITA GEREAN CRAIGHEAD-DAVIS M.ED, LPC, LCAS, CCS

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	101YM0800X	Mental Health Counselor	4116	NC
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	1285	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568568970
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHINITA GEREAN CRAIGHEAD-DAVIS M.ED, LPC, LCAS, CCS

Provider Business Mailing Address
First Line	:	3205 FREEDOM DR STE 2000
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28208-3486
Country	:	US
Telephone Number	:	704-816-0260
Fax Number	:

Provider Business Practice Location Address
First Line	:	3205 FREEDOM DR STE 2000
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28208-3486
Country	:	US
Telephone Number	:	704-816-0260
Fax Number	:

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

Provider Enumeration Date	:	09/15/2006
Last Update Date	:	04/15/2020

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