Provider Demographics
NPI:1336992965
Name:DAVENPORT, NICHOLAS J (LCSW-C)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:J
Last Name:DAVENPORT
Suffix:
Gender:M
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 33492
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-0404
Mailing Address - Country:US
Mailing Address - Phone:443-413-9780
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 33492
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-0404
Practice Address - Country:US
Practice Address - Phone:443-413-9780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-11
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD198711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical