Provider Demographics
NPI:1285616912
Name:DAVENPORT, LAURA (LPC)
Entity type:Individual
Prefix:MRS
First Name:LAURA
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:PO BOX 1558
Mailing Address - Street 2:
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677-0031
Mailing Address - Country:US
Mailing Address - Phone:706-548-9545
Mailing Address - Fax:706-548-9976
Practice Address - Street 1:1020 BARBER CREEK DR STE 213
Practice Address - Street 2:STE.213
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677-5984
Practice Address - Country:US
Practice Address - Phone:706-548-9545
Practice Address - Fax:706-548-9976
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-17
Last Update Date:2009-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC003222101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health