Provider Demographics
NPI:1447422860
Name:SAUNDERS-DAVENPORT, KHADISHA (MA, LLPC, CAADC, CAS)
Entity Type:Individual
Prefix:MRS
First Name:KHADISHA
Middle Name:
Last Name:SAUNDERS-DAVENPORT
Suffix:
Gender:F
Credentials:MA, LLPC, CAADC, CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29193 NORTHWESTERN HIGHWAY
Mailing Address - Street 2:UNIT 781
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034
Mailing Address - Country:US
Mailing Address - Phone:313-784-5560
Mailing Address - Fax:
Practice Address - Street 1:26522 VAN DYKE AVE
Practice Address - Street 2:
Practice Address - City:CENTER LINE
Practice Address - State:MI
Practice Address - Zip Code:48015-1221
Practice Address - Country:US
Practice Address - Phone:586-759-4400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-26
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401009009101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health