Individual provider Active NPI

Glacia Ethridge Davis, LCMHC, LPC, CRC, NCC

  • Mental Health Counselor
  • North Charleston, SC
National Provider Identifier
1447869763
Registry record updated Apr 28, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
15500 Issued in NC
Practice address
6650 Rivers Ave Ste 100
North Charleston, SC 29406-4809
Phone
(803) 606-9932
NPI assigned
Jul 23, 2020
Last updated
Apr 28, 2026By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 28, 2026

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X 10865 SC
Addiction (Substance Use Disorder) Counselor 101YA0400X 24415 NC
Mental Health Counselor 101YM0800X 15500 NC Primary

Addresses

Primary practice location

6650 Rivers Ave Ste 100
North Charleston, SC 29406-4809

Mailing address

224 Fox Run Dr
Hopkins, SC 29061-8662
Phone (803) 606-9932

Other practice location 1

4030 Wake Forest Rd Ste 349
Raleigh, NC 27609-0010
Phone (803) 606-9932

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
15500NCMDMental Health Counselor
24415NCMDPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist

NPI Registry JSON

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

{
    "created_epoch": "1595462400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1777334400000",
    "number": "1447869763",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "224 FOX RUN DR",
            "city": "HOPKINS",
            "state": "SC",
            "postal_code": "290618662",
            "telephone_number": "803-606-9932"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6650 RIVERS AVE STE 100",
            "city": "NORTH CHARLESTON",
            "state": "SC",
            "postal_code": "294064809",
            "telephone_number": "803-606-9932"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4030 Wake Forest Rd Ste 349",
            "address_purpose": "LOCATION",
            "city": "Raleigh",
            "state": "NC",
            "postal_code": "276090010",
            "country_code": "US",
            "telephone_number": "803-606-9932",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "GLACIA",
        "middle_name": "ETHRIDGE",
        "name_prefix": "Dr.",
        "credential": "LCMHC, LPC, CRC, NCC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-07-23",
        "last_updated": "2026-04-28",
        "certification_date": "2026-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "SC",
            "license": "10865",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NC",
            "license": "24415",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NC",
            "license": "15500",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in North Charleston, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2026; 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.