Provider Demographics
NPI:1720814890
Name:DAVENPORT, BARBARA WILSON
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:WILSON
Last Name:DAVENPORT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 DORCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29483-3740
Mailing Address - Country:US
Mailing Address - Phone:843-367-7092
Mailing Address - Fax:
Practice Address - Street 1:5421 RIVER BLUFF PKWY
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29420-7135
Practice Address - Country:US
Practice Address - Phone:843-300-0440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-13
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8080101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health