Provider Demographics
NPI:1225876626
Name:DAVIS, KY'ASIA LAJAE (LCSWA)
Entity type:Individual
Prefix:
First Name:KY'ASIA
Middle Name:LAJAE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 804
Mailing Address - Street 2:
Mailing Address - City:AHOSKIE
Mailing Address - State:NC
Mailing Address - Zip Code:27910-0804
Mailing Address - Country:US
Mailing Address - Phone:252-287-1780
Mailing Address - Fax:252-332-2416
Practice Address - Street 1:400 PEACOCK ST
Practice Address - Street 2:
Practice Address - City:AHOSKIE
Practice Address - State:NC
Practice Address - Zip Code:27910-3930
Practice Address - Country:US
Practice Address - Phone:252-332-2297
Practice Address - Fax:252-332-2416
Is Sole Proprietor?:No
Enumeration Date:2024-07-18
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP020903104100000X
NCPO209031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker