Kenneth Wayne Davis, SAC
Individual provider Active NPI Addiction (Substance Use Disorder) Counselor · Bentonville, AR
NPI 1124384359 · NPPES record last updated Nov 6, 2013
Key facts
- NPI
- 1124384359
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Addiction (Substance Use Disorder) Counselor 101YA0400X
- License
- 15651131 (WI)
- Practice address
- 1002 SE C St
Bentonville, AR 72712-6327 - Phone
- (479) 271-2120
- Fax
- (479) 271-2219
- NPI assigned
- Apr 2, 2012
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 15651131 | WI | MD | Addiction (Substance Use Disorder) Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sweet Emotions Counseling LLC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 15651131 | WI | Yes |
Addresses
Primary practice location
1002 SE C St
Bentonville, AR 72712-6327
Mailing address
1002 SE C St
Bentonville, AR 72712-6327
Phone (479) 271-2120
Other names
- Mr. Kenneth W Davis
Other providers in Bentonville, AR
- Lori Davenport
- David T. Drummond, D.D.S., P.a.
- Trevor Davidson
- Bailey Davis
- Kelly Anne Davis
- Letara Davis
- Manda J Davis
- Taylor Davis
- Tonya Davis
- Tresa Davis
All providers in Bentonville, AR · Addiction (Substance Use Disorder) Counselor in Arkansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 6, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.