Doctor Name: | MS. ANNETTA M. G. DAVENPORT |
NPI Number: | 1710294749 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LMHC |
License Number: | MH9997 |
Business Practice Address: | 124 E Miracle Strip Pkwy Ste 204 Mary Esther, FL - 325691990 |
Business Phone Number: | 8502267100 |
Business Fax Number: | 8502267157 |
Mailing Address: | 124 E Miracle Strip Pkwy Ste 204, MARY ESTHER |
State: | FL |
Postal Code: | 325691990 |
Phone Number: | 8502267100 |
Fax Number: | 8502267157 |
NPI Enumeration Date: | 09/13/2010 |
NPI Last Update Date: | 06/15/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | MH9997 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | FL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |