Provider Demographics
NPI:1235204074
Name:DAVENPORT, JOANNE G (MA)
Entity Type:Individual
Prefix:MISS
First Name:JOANNE
Middle Name:G
Last Name:DAVENPORT
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 1:610 S COLLEGE RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-3202
Mailing Address - Country:US
Mailing Address - Phone:910-799-1071
Mailing Address - Fax:910-799-3313
Practice Address - Street 1:610 S COLLEGE RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-3202
Practice Address - Country:US
Practice Address - Phone:910-799-1071
Practice Address - Fax:910-799-3313
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2865101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC11548OtherNCBCBS