Provider Demographics
NPI:1699105403
Name:DAVIS, CASONJA (MA, LPC, NCC)
Entity type:Individual
Prefix:
First Name:CASONJA
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 IVYGLEN CT
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27406-9287
Mailing Address - Country:US
Mailing Address - Phone:910-473-0685
Mailing Address - Fax:
Practice Address - Street 1:505 S CHURCH ST
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203-5673
Practice Address - Country:US
Practice Address - Phone:910-473-0685
Practice Address - Fax:336-625-6113
Is Sole Proprietor?:No
Enumeration Date:2013-11-14
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC318704101YM0800X
NC10295101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health