Provider Demographics
NPI:1285849240
Name:DAVIS, KEVIN RUTH (MSW)
Entity type:Individual
Prefix:MS
First Name:KEVIN
Middle Name:RUTH
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 MOUNT VERNON AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-4840
Mailing Address - Country:US
Mailing Address - Phone:704-332-4588
Mailing Address - Fax:704-375-3949
Practice Address - Street 1:701 MOUNT VERNON AVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-4840
Practice Address - Country:US
Practice Address - Phone:704-332-4588
Practice Address - Fax:704-375-3949
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical