Provider Demographics
NPI:1730401597
Name:BROCK, MEISSA DAVIS (LCAS)
Entity type:Individual
Prefix:MRS
First Name:MEISSA
Middle Name:DAVIS
Last Name:BROCK
Suffix:
Gender:F
Credentials:LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 MCKAYLA LN
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27530-9277
Mailing Address - Country:US
Mailing Address - Phone:919-735-6771
Mailing Address - Fax:
Practice Address - Street 1:1041 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27605-1259
Practice Address - Country:US
Practice Address - Phone:888-305-4321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-22
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC921101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)