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Individual

MR. KENNETH WAYNE DAVIS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
SAC

Contact information

Practice address
1002 SE C ST, BENTONVILLE, AR 72712-6327
(479) 271-2120
(479) 271-2219
Mailing address
1002 SE C ST, BENTONVILLE, AR 72712-6327
(479) 271-2120
(479) 271-2219

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
15651131
WI

Other

Enumeration date
04/02/2012
Last updated
11/06/2013
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