1982939468 NPI number — LORETTA H DAVIS LPC, LCAS

Table of content: LORETTA H DAVIS LPC, LCAS (NPI 1982939468)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982939468 NPI number — LORETTA H DAVIS LPC, LCAS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DAVIS
Provider First Name:
LORETTA
Provider Middle Name:
H
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LPC, LCAS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DAVIS
Provider Other First Name:
LORI
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPC, LCAS
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1982939468
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/11/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1000 N 1ST ST
Provider Second Line Business Mailing Address:
SUITE 1
Provider Business Mailing Address City Name:
ALBEMARLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28001-2833
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-983-2117
Provider Business Mailing Address Fax Number:
704-983-2636

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
284 EXECUTIVE PARK DR
Provider Second Line Business Practice Location Address:
STE 100
Provider Business Practice Location Address City Name:
CONCORD
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28025-1831
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-939-1100
Provider Business Practice Location Address Fax Number:
704-939-1173
Provider Enumeration Date:
10/16/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  7577 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YA0400X , with the licence number: 1525 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1982939468 . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1982939468 . This is a "MAGELLAN" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1982939468 . This is a "UNITED BEHAVIORAL HEALTH" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1982939468 . This is a "HUMANA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1982939468 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1982939468 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1982939468 . This is a "OPTUM" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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