Provider Demographics
NPI:1578206298
Name:DAVENPORT, KIARA SHANIECE
Entity Type:Individual
Prefix:
First Name:KIARA
Middle Name:SHANIECE
Last Name:DAVENPORT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:589 STEWARTS FERRY PIKE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37214-3414
Mailing Address - Country:US
Mailing Address - Phone:629-255-0516
Mailing Address - Fax:
Practice Address - Street 1:589 STEWARTS FERRY PIKE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37214-3414
Practice Address - Country:US
Practice Address - Phone:629-255-0516
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-20
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)