Provider Demographics
NPI:1831434653
Name:CAMPBELL-DAVENPORT, KIRSTEN LIL'VON (BA PSYCHOLOGY)
Entity type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:LIL'VON
Last Name:CAMPBELL-DAVENPORT
Suffix:
Gender:F
Credentials:BA PSYCHOLOGY
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1720 E COLLEGE AVE APT 45
Mailing Address - Street 2:
Mailing Address - City:GUTHRIE
Mailing Address - State:OK
Mailing Address - Zip Code:73044-4542
Mailing Address - Country:US
Mailing Address - Phone:918-206-3953
Mailing Address - Fax:
Practice Address - Street 1:1777 S BURLINGTON BLVD UNIT 271
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98233-3223
Practice Address - Country:US
Practice Address - Phone:360-503-3815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-05
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
101YM0800X
WABD61609590374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health