Provider Demographics
NPI:1760148530
Name:DAVENPORT, JENNIFER KRISTEN (MS, LCADC, CCS)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:KRISTEN
Last Name:DAVENPORT
Suffix:
Gender:F
Credentials:MS, LCADC, CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1930 MARLTON PIKE E STE E27
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-4101
Mailing Address - Country:US
Mailing Address - Phone:732-231-5180
Mailing Address - Fax:732-231-5189
Practice Address - Street 1:1930 MARLTON PIKE E STE E27
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-4101
Practice Address - Country:US
Practice Address - Phone:732-231-5180
Practice Address - Fax:732-231-5189
Is Sole Proprietor?:No
Enumeration Date:2021-11-16
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00339600101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)