Individual
MR. DERRICK LAVEL DAVIS SR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
4601 PARK RD STE 400, CHARLOTTE, NC 28209-2284
(704) 344-0491
(704) 344-0493
Mailing address
PO BOX 563328, CHARLOTTE, NC 28256-3328
(704) 449-1750
(704) 730-8040
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
6103353
NC
101YM0800X
Mental Health Counselor
Primary
5084
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6103353
—
NC
Enumeration date
10/11/2007
Last updated
04/07/2010
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