Provider Demographics
NPI:1760023402
Name:DAVIS, ARNETTA K (MSSA,LSW)
Entity Type:Individual
Prefix:
First Name:ARNETTA
Middle Name:K
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MSSA,LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6474 WINCHESTER HIGHLANDS DR
Mailing Address - Street 2:
Mailing Address - City:CANAL WINCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:43110-9126
Mailing Address - Country:US
Mailing Address - Phone:614-439-2793
Mailing Address - Fax:
Practice Address - Street 1:825 GRANDVIEW AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-1123
Practice Address - Country:US
Practice Address - Phone:614-285-3751
Practice Address - Fax:614-487-9319
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-03
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.1904407104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker