Provider Demographics
NPI:1528361250
Name:DAVIS, DONALD WADE (LMSW)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:WADE
Last Name:DAVIS
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 N EAST ST
Mailing Address - Street 2:
Mailing Address - City:PAOLA
Mailing Address - State:KS
Mailing Address - Zip Code:66071-1591
Mailing Address - Country:US
Mailing Address - Phone:913-557-9096
Mailing Address - Fax:913-294-4996
Practice Address - Street 1:401 N EAST ST
Practice Address - Street 2:
Practice Address - City:PAOLA
Practice Address - State:KS
Practice Address - Zip Code:66071-1591
Practice Address - Country:US
Practice Address - Phone:913-557-9096
Practice Address - Fax:913-294-4996
Is Sole Proprietor?:No
Enumeration Date:2010-12-20
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLMSW 7798104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker