MEDICARE: DOMINIQUE A DAVENPORT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	LGP15716	MD

General Provider Information

NPI Number	:	1932929783
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOMINIQUE A DAVENPORT

Provider Business Mailing Address
First Line	:	11700 AMER CT
Second Line	:
City	:	FORT WASHINGTON
State	:	MD
Zip	:	20744-5953
Country	:	US
Telephone Number	:	202-821-9342
Fax Number	:

Provider Business Practice Location Address
First Line	:	11700 AMER CT
Second Line	:
City	:	FORT WASHINGTON
State	:	MD
Zip	:	20744-5953
Country	:	US
Telephone Number	:	202-821-9342
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/16/2024
Last Update Date	:	10/16/2024

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Directions to “ DOMINIQUE A DAVENPORT ” Practice Location

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