Active NPI
Samuel C Davis Jr., MAED, LPC
- School Counselor
- Albemarle, NC
National Provider Identifier
1295911204
On this page
Key facts
NPPES NPI Registry- Primary specialty
- School Counselor
- License
- 2642
- Practice address
- 29086 Jordan Pond Dr
Albemarle, NC 28001-6419 - Phone
- (704) 982-1266
- NPI assigned
- Jan 21, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | 2642 | NC | |
| Mental Health Counselor | 101YM0800X | 2642 | NC | |
| Professional Counselor | 101YP2500X | 2642 | NC | |
| School Counselor | 101YS0200X | 2642 | NC | Primary |
Addresses
Primary practice location
29086 Jordan Pond Dr
Albemarle, NC 28001-6419
Mailing address
29086 Jordan Pond Dr
Albemarle, NC 28001-6419
Phone (704) 982-1266
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 |
|---|---|---|---|
| 2642 | NC | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1200873600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1276560000000",
"number": "1295911204",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "29086 JORDAN POND DR",
"city": "ALBEMARLE",
"state": "NC",
"postal_code": "280016419",
"telephone_number": "704-982-1266"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "29086 JORDAN POND DR",
"city": "ALBEMARLE",
"state": "NC",
"postal_code": "280016419",
"telephone_number": "704-982-1266"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIS",
"first_name": "SAMUEL",
"middle_name": "C",
"name_prefix": "Mr.",
"name_suffix": "Jr.",
"credential": "MAED, LPC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-01-21",
"last_updated": "2010-06-15",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "NC",
"license": "2642",
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "NC",
"license": "2642",
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "NC",
"license": "2642",
"primary": false
},
{
"code": "101YS0200X",
"taxonomy_group": "",
"desc": "Counselor, School",
"state": "NC",
"license": "2642",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Albemarle, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 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.