Healthcare Provider Details

I. General information

NPI: 1316236391
Provider Name (Legal Business Name): DAVENPORT COUNSELING ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2011
Last Update Date: 03/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

539 CENTER ST
BETHLEHEM PA
18018-5910
US

IV. Provider business mailing address

7162 SCENIC VIEW DR
MACUNGIE PA
18062-2126
US

V. Phone/Fax

Practice location:
  • Phone: 610-737-6507
  • Fax:
Mailing address:
  • Phone: 610-737-6507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC000979
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW002402L
License Number StatePA

VIII. Authorized Official

Name: MELINDA NABORS DAVENPORT
Title or Position: PRESIDENT
Credential: M.A., L.P.C., N.C.P,
Phone: 610-737-6507