Healthcare Provider Details

I. General information

NPI: 1881186674
Provider Name (Legal Business Name): DONTISHA R DAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2018
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 WELLNESS WAY
HOT SPRINGS AR
71913-6478
US

IV. Provider business mailing address

125 WELLNESS WAY
HOT SPRINGS AR
71913-6478
US

V. Phone/Fax

Practice location:
  • Phone: 501-624-7111
  • Fax: 501-620-5109
Mailing address:
  • Phone: 501-624-7111
  • Fax: 501-620-5109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number8010
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: