Individual
JACQUELINE DAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1309 NORTHUP ST STE F, REIDSVILLE, NC 27320-5611
(336) 312-7761
Mailing address
1309 NORTHUP ST, REIDSVILLE, NC 27320-5611
(336) 312-7761
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
14350
NC
Other
Enumeration date
06/03/2018
Last updated
06/03/2018
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