Provider Demographics
NPI:1588202873
Name:DAVIS, JOHNNY (LPC)
Entity Type:Individual
Prefix:
First Name:JOHNNY
Middle Name:
Last Name:DAVIS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 WEST MAIN STREET, SUITE 201
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72801
Mailing Address - Country:US
Mailing Address - Phone:479-968-2001
Mailing Address - Fax:479-964-2075
Practice Address - Street 1:400 HARDIN RD STE 150
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-3507
Practice Address - Country:US
Practice Address - Phone:501-603-2147
Practice Address - Fax:501-603-0324
Is Sole Proprietor?:No
Enumeration Date:2019-12-17
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP2208005101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional