Active NPI
Derrick Lavel Davis Sr., LPC
- Mental Health Counselor
- Charlotte, NC
National Provider Identifier
1265620611
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 5084
- Practice address
- 4601 Park Rd Ste 400
Charlotte, NC 28209-2284 - Phone
- (704) 344-0491
- Fax
- (704) 344-0493
- NPI assigned
- Oct 11, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 6103353 | NC | |
| Mental Health Counselor | 101YM0800X | 5084 | NC | Primary |
Addresses
Primary practice location
4601 Park Rd Ste 400
Charlotte, NC 28209-2284
Mailing address
PO Box 563328
Charlotte, NC 28256-3328
Phone (704) 449-1750
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6103353 | Medicaid | NC |
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
| License | State | Type | Specialty |
|---|---|---|---|
| 6103353 | NC | MD | Addiction (Substance Use Disorder) Counselor |
| 5084 | NC | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1192060800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1270598400000",
"number": "1265620611",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 563328",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282563328",
"telephone_number": "704-449-1750",
"fax_number": "704-730-8040"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4601 PARK RD STE 400",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282092284",
"telephone_number": "704-344-0491",
"fax_number": "704-344-0493"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIS",
"first_name": "DERRICK",
"middle_name": "LAVEL",
"name_prefix": "Mr.",
"name_suffix": "Sr.",
"credential": "LPC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-10-11",
"last_updated": "2010-04-07",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "NC",
"license": "6103353",
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "NC",
"license": "5084",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "6103353",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Charlotte, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.