Individual
KENYATTA NECOLE DAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1995 BLUE ROCK CT, GREENSBORO, NC 27405-1834
(336) 340-6399
Mailing address
1995 BLUE ROCK CT, GREENSBORO, NC 27405-1834
(336) 340-6399
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
MHL-041-1232
NC
Other
Enumeration date
08/31/2022
Last updated
08/31/2022
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