Provider Demographics
NPI:1467587766
Name:DAVIS, KENYA (A&D COUNSELOR, TRAIN)
Entity Type:Individual
Prefix:MS
First Name:KENYA
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:A&D COUNSELOR, TRAIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1107 TACE DR
Mailing Address - Street 2:APT. 2B
Mailing Address - City:ESSEX
Mailing Address - State:MD
Mailing Address - Zip Code:21221-5723
Mailing Address - Country:US
Mailing Address - Phone:443-854-3447
Mailing Address - Fax:
Practice Address - Street 1:39 E CHURCHVILLE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-3800
Practice Address - Country:US
Practice Address - Phone:410-420-6572
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTRAINEE STATUS101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)