| Doctor Name: | MR. KENNETH WAYNE DAVIS |
| NPI Number: | 1124384359 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | SAC |
| License Number: | 15651131 |
| Business Practice Address: | 1002 Se C St Bentonville, AR - 727126327 |
| Business Phone Number: | 4792712120 |
| Business Fax Number: | 4792712219 |
| Mailing Address: | 1002 Se C St, BENTONVILLE |
| State: | AR |
| Postal Code: | 727126327 |
| Phone Number: | 4792712120 |
| Fax Number: | 4792712219 |
| NPI Enumeration Date: | 04/02/2012 |
| NPI Last Update Date: | 11/06/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 15651131 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |