Provider Demographics
NPI:1033620299
Name:DAVENPORT, SHANTONE TOLIVER (MS, LMHC)
Entity Type:Individual
Prefix:MRS
First Name:SHANTONE
Middle Name:TOLIVER
Last Name:DAVENPORT
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2546 STORMY CIR
Mailing Address - Street 2:
Mailing Address - City:NAVARRE
Mailing Address - State:FL
Mailing Address - Zip Code:32566-9060
Mailing Address - Country:US
Mailing Address - Phone:904-704-0411
Mailing Address - Fax:
Practice Address - Street 1:1913 HIGHWAY 87
Practice Address - Street 2:
Practice Address - City:NAVARRE
Practice Address - State:FL
Practice Address - Zip Code:32566-1017
Practice Address - Country:US
Practice Address - Phone:850-692-9824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-16
Last Update Date:2017-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH14799101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health