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General NPI Number Information
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NPI Number | 1164753802
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Entity Type | Individual
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Provider Name | AYESHA DAVENPORT MA, LPC
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Gender | Female
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Dates
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Enumeration Date | 01/20/2010
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Last Update Date | 01/09/2024
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Provider Practice Location Address
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Address Line | 6618 S 23RD AVE
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City | PHOENIX
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State | AZ
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Zip | 85041-5358
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Country | US
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Telephone | 215-206-7189
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Fax |
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Provider Business Mailing Address
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Address Line | 6618 S 23RD AVE
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City | PHOENIX
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State | AZ
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Zip | 85041-5358
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Country | US
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Telephone | 215-206-7189
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | AZ-16913
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License Number State | AZ
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