Provider Demographics
NPI:1942375076
Name:DAVENPORT, RICHARD K (MS, LCPC)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:K
Last Name:DAVENPORT
Suffix:
Gender:M
Credentials:MS, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:823 BURNT MILLS AVE
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-1444
Mailing Address - Country:US
Mailing Address - Phone:301-922-7311
Mailing Address - Fax:301-531-4735
Practice Address - Street 1:823 BURNT MILLS AVE
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20901-1444
Practice Address - Country:US
Practice Address - Phone:301-922-7311
Practice Address - Fax:301-531-4735
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1680101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD003082100Medicaid