Provider Demographics
NPI:1851084446
Name:DAVENPORT, LATANYA (BS ,MDIV ,CGS)
Entity Type:Individual
Prefix:
First Name:LATANYA
Middle Name:
Last Name:DAVENPORT
Suffix:
Gender:F
Credentials:BS ,MDIV ,CGS
Other - Prefix:
Other - First Name:HEALING
Other - Middle Name:
Other - Last Name:HANDS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:HEALING HANDS
Mailing Address - Street 1:PO BOX 71204
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23255-1204
Mailing Address - Country:US
Mailing Address - Phone:434-569-0362
Mailing Address - Fax:
Practice Address - Street 1:8734 ALDEBURGH DRIVE
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23294
Practice Address - Country:US
Practice Address - Phone:434-569-0362
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-30
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral