Provider Demographics
NPI:1235527433
Name:DAVENPORT, MARK (LMHC)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:DAVENPORT
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1592 FRANCOIS CT
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-7594
Mailing Address - Country:US
Mailing Address - Phone:407-470-7139
Mailing Address - Fax:
Practice Address - Street 1:1592 FRANCOIS COURT
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-7594
Practice Address - Country:US
Practice Address - Phone:407-470-7139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-23
Last Update Date:2014-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH1600101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health