Provider Demographics
NPI:1386963049
Name:DAVIS, NINA MICHELE (LPC)
Entity type:Individual
Prefix:
First Name:NINA
Middle Name:MICHELE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:NINA
Other - Middle Name:MICHELE
Other - Last Name:GONZALEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:4804 STOWE DERBY DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28278-7342
Mailing Address - Country:US
Mailing Address - Phone:704-999-7588
Mailing Address - Fax:704-971-2046
Practice Address - Street 1:4804 STOWE DERBY DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28278-7342
Practice Address - Country:US
Practice Address - Phone:704-999-7588
Practice Address - Fax:704-971-2046
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-20
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4997101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health