Provider Demographics
NPI:1740215599
Name:DAVIS, KENYA T (LCSW)
Entity Type:Individual
Prefix:
First Name:KENYA
Middle Name:T
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 JOANNE CIR
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-5234
Mailing Address - Country:US
Mailing Address - Phone:919-740-5888
Mailing Address - Fax:
Practice Address - Street 1:2949 NEW BERN AVE STE 107
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-1248
Practice Address - Country:US
Practice Address - Phone:919-747-9843
Practice Address - Fax:919-747-9845
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0048651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6003349Medicaid