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General NPI Number Information
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NPI Number | 1760148530
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Entity Type | Individual
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Provider Name | JENNIFER KRISTEN DAVENPORT MS, LCADC, CCS
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Gender | Female
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Dates
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Enumeration Date | 11/16/2021
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Last Update Date | 11/16/2021
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Provider Practice Location Address
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Address Line | 1930 MARLTON PIKE E STE E27
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City | CHERRY HILL
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State | NJ
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Zip | 08003-4101
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Country | US
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Telephone | 732-231-5180
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Fax | 732-231-5189
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Provider Business Mailing Address
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Address Line | 1930 MARLTON PIKE E STE E27
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City | CHERRY HILL
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State | NJ
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Zip | 08003-4101
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Country | US
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Telephone | 732-231-5180
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Fax | 732-231-5189
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 37LC00339600
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License Number State | NJ
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