Active NPI
Tina Lynne Davis, MS, LPC
- Professional Counselor
- Jacksonville, NC
National Provider Identifier
1104198035
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 9220
- Practice address
- 165 Center St
Jacksonville, NC 28546-5708 - Phone
- (910) 550-4836
- NPI assigned
- Feb 8, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 9220 | NC | Primary |
Addresses
Primary practice location
165 Center St
Jacksonville, NC 28546-5708
Mailing address
315 Otter Creek CT
Richlands, NC 28574-8441
Phone (518) 368-8409
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9220 | NC | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1328659200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1357776000000",
"number": "1104198035",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "315 OTTER CREEK CT",
"city": "RICHLANDS",
"state": "NC",
"postal_code": "285748441",
"telephone_number": "518-368-8409"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "165 CENTER ST",
"city": "JACKSONVILLE",
"state": "NC",
"postal_code": "285465708",
"telephone_number": "910-550-4836"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIS",
"first_name": "TINA",
"middle_name": "LYNNE",
"credential": "MS, LPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-02-08",
"last_updated": "2013-01-10",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "NC",
"license": "9220",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jacksonville, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.