Provider Demographics
NPI:1962938589
Name:DAVIS, ELLEN HALL (MA, LCMHC)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:HALL
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MA, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 PINEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:KINGS MOUNTAIN
Mailing Address - State:NC
Mailing Address - Zip Code:28086-3531
Mailing Address - Country:US
Mailing Address - Phone:704-718-7075
Mailing Address - Fax:
Practice Address - Street 1:408 PINEVIEW DR
Practice Address - Street 2:
Practice Address - City:KINGS MOUNTAIN
Practice Address - State:NC
Practice Address - Zip Code:28086-3531
Practice Address - Country:US
Practice Address - Phone:704-718-7075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-02
Last Update Date:2025-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1229612101YS0200X
NC12843101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool