Provider Demographics
NPI:1417567967
Name:DAVENPORT, KATHRYN (LCSW-C)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:DAVENPORT
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14821 LAKE TER
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20853-3632
Mailing Address - Country:US
Mailing Address - Phone:301-233-4428
Mailing Address - Fax:
Practice Address - Street 1:14821 LAKE TER
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20853-3632
Practice Address - Country:US
Practice Address - Phone:301-233-4428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-08
Last Update Date:2020-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD189391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical