Provider Demographics
NPI:1386325512
Name:DAVILA ORTIZ, KENIA NAHOMI (MA)
Entity type:Individual
Prefix:
First Name:KENIA
Middle Name:NAHOMI
Last Name:DAVILA ORTIZ
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1857 WELLS RD STE 2016
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-2338
Mailing Address - Country:US
Mailing Address - Phone:904-523-1287
Mailing Address - Fax:904-615-6919
Practice Address - Street 1:1857 WELLS RD STE 2016
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-2338
Practice Address - Country:US
Practice Address - Phone:904-523-1287
Practice Address - Fax:904-615-6919
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-31
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101YA0400X, 101YP1600X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral