MEDICARE: TASHECKA RENEE 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
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	26494	NC
2	101YM0800X	Mental Health Counselor	19689	NC

General Provider Information

NPI Number	:	1710597612
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TASHECKA RENEE DAVIS

Provider Business Mailing Address
First Line	:	5015 RAINMAKER DR
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27704-2299
Country	:	US
Telephone Number	:	919-899-4531
Fax Number	:	919-822-9879

Provider Business Practice Location Address
First Line	:	5015 RAINMAKER DR
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27704-2299
Country	:	US
Telephone Number	:	919-907-8973
Fax Number	:

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

Provider Enumeration Date	:	08/05/2020
Last Update Date	:	06/20/2026

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