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General NPI Number Information
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NPI Number | 1255578191
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Entity Type | Organization
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Legal Business Name | DAVENPORT DIAGNOSTIC AND TREATMENT CENTER, INC
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Dates
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Enumeration Date | 01/14/2009
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Last Update Date | 01/14/2009
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Provider Practice Location Address
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Address Line | 14275 MIDWAY RD SUITE 220
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City | ADDISON
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State | TX
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Zip | 75001-3614
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Country | US
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Telephone | 972-850-0720
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Fax |
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Provider Business Mailing Address
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Address Line | 14275 MIDWAY RD SUITE 220
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City | ADDISON
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State | TX
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Zip | 75001-3614
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Country | US
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Telephone | 972-850-0720
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Fax |
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Authorized Official
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Title or Position | PSYCOLOGIST
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Name | DR. KIMBERLY C JOHNSON
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Credential | PSYD
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Telephone | 972-850-0720
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | 32698
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 32578
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License Number State | TX
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