MEDICARE: KAWONI ALETHEA DAVIS LMSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	LMSW-21707	AZ

General Provider Information

NPI Number	:	1104604420
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAWONI ALETHEA DAVIS LMSW

Provider Business Mailing Address
First Line	:	9625 N 43RD DR
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85302-3805
Country	:	US
Telephone Number	:	623-845-2352
Fax Number	:

Provider Business Practice Location Address
First Line	:	9625 N 43RD DR
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85302-3805
Country	:	US
Telephone Number	:	623-845-2352
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/18/2023
Last Update Date	:	09/18/2023

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