Provider Demographics
NPI:1548396716
Name:DAVENPORT, MARK
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:DAVENPORT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:584 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-3927
Mailing Address - Country:US
Mailing Address - Phone:209-609-1843
Mailing Address - Fax:
Practice Address - Street 1:887 POTRERO AVE
Practice Address - Street 2:UNITL L
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-2869
Practice Address - Country:US
Practice Address - Phone:415-206-3311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor