Provider Demographics
NPI:1104478346
Name:DAVIS, DAKIA ANLAURA (LICSW)
Entity type:Individual
Prefix:
First Name:DAKIA
Middle Name:ANLAURA
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 SARDIS DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27603-2715
Mailing Address - Country:US
Mailing Address - Phone:888-308-4325
Mailing Address - Fax:
Practice Address - Street 1:1100 LOGGER CT STE H101
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-8513
Practice Address - Country:US
Practice Address - Phone:888-308-4325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-09
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC500811911041C0700X
NCC0128381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical