Individual
MANDA J DAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LADAC,BCC
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
365L
AR
Other
Enumeration date
11/06/2013
Last updated
11/06/2013
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