Provider Demographics
NPI:1801297965
Name:DAVENPORT, JULIE (CRC, LPC)
Entity type:Individual
Prefix:MS
First Name:JULIE
Middle Name:
Last Name:DAVENPORT
Suffix:
Gender:F
Credentials:CRC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2446 N VERMONT AVE
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-4206
Mailing Address - Country:US
Mailing Address - Phone:248-310-6608
Mailing Address - Fax:
Practice Address - Street 1:2446 N VERMONT AVE
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-4206
Practice Address - Country:US
Practice Address - Phone:248-310-6608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-09
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401014128101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional