Provider Demographics
NPI:1720642564
Name:DAVIS, MEREDITH ALYSSA (LCSWA)
Entity type:Individual
Prefix:
First Name:MEREDITH
Middle Name:ALYSSA
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 1775
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27528-1775
Mailing Address - Country:US
Mailing Address - Phone:919-793-6445
Mailing Address - Fax:919-803-4764
Practice Address - Street 1:310 NEW FIDELITY CT
Practice Address - Street 2:
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529-2665
Practice Address - Country:US
Practice Address - Phone:919-793-6445
Practice Address - Fax:919-803-4764
Is Sole Proprietor?:No
Enumeration Date:2019-04-26
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0124381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical