Provider Demographics
NPI:1376623652
Name:DAVENPORT - DAKIN, AMY MARIE (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:MARIE
Last Name:DAVENPORT - DAKIN
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:DAVENPORT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:76 FAIRVIEW AVE STE C
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-5832
Mailing Address - Country:US
Mailing Address - Phone:603-257-0258
Mailing Address - Fax:888-977-1570
Practice Address - Street 1:76 FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-5832
Practice Address - Country:US
Practice Address - Phone:603-257-0258
Practice Address - Fax:888-977-1570
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME2166101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME266310000Medicaid
ME266310000Medicaid