Provider Demographics
NPI:1083189971
Name:DAVENPORT, DIANA (LPC)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:DAVENPORT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5102 YOKOSUKA DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78413-5356
Mailing Address - Country:US
Mailing Address - Phone:361-779-7953
Mailing Address - Fax:
Practice Address - Street 1:4646 CORONA DR STE 222
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-4393
Practice Address - Country:US
Practice Address - Phone:361-985-1849
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-08
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX72991101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional