Provider Demographics
NPI:1366202228
Name:CRAIGHEAD-DAVIS, VICKIE
Entity type:Individual
Prefix:
First Name:VICKIE
Middle Name:
Last Name:CRAIGHEAD-DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5028 CHESTNUT KNOLL LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-8239
Mailing Address - Country:US
Mailing Address - Phone:704-713-2362
Mailing Address - Fax:
Practice Address - Street 1:4435 E W T HARRIS BLVD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28215-1912
Practice Address - Country:US
Practice Address - Phone:704-713-2362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator