NPIMap

Individual provider Active NPI

Candace Peterson Davis, LPC

  • Mental Health Counselor
  • Winston-Salem, NC
National Provider Identifier
1154543783
Registry record updated Mar 16, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
3871 Issued in NC
Practice address
3821 Forrestgate Drive
Dba Forsyth Behavior Health
Winston-Salem, NC 27103
Phone
(336) 277-1811
NPI assigned
May 3, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 16, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X 3871 NC Primary
Addiction (Substance Use Disorder) Counselor 101YA0400X 706 NC

Addresses

Primary practice location

3821 Forrestgate Drive
Dba Forsyth Behavior Health
Winston-Salem, NC 27103

Mailing address

2000 Frontis Plaza Blvd
Suite 200 (Forsyth Medical Group)
Winston-Salem, NC 27103-5616
Phone (336) 277-2435

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

State licenses

LicenseStateTypeSpecialty
3871NCMDMental Health Counselor

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1178150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1426464000000",
    "number": "1154543783",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2000 FRONTIS PLAZA BLVD",
            "address_2": "SUITE 200 (FORSYTH MEDICAL GROUP)",
            "city": "WINSTON-SALEM",
            "state": "NC",
            "postal_code": "271035616",
            "telephone_number": "336-277-2435",
            "fax_number": "336-277-9275"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3821 FORRESTGATE DRIVE",
            "address_2": "DBA FORSYTH BEHAVIOR HEALTH",
            "city": "WINSTON-SALEM",
            "state": "NC",
            "postal_code": "27103",
            "telephone_number": "336-277-1811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "CANDACE",
        "middle_name": "PETERSON",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-03",
        "last_updated": "2015-03-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NC",
            "license": "3871",
            "primary": true
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NC",
            "license": "706",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Winston-Salem, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.