Provider Demographics
NPI:1972713246
Name:DAVENPORT, LESLIE DUNN (MFT)
Entity type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:DUNN
Last Name:DAVENPORT
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 SIR FRANCIS DRAKE BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:KENTFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94904-1411
Mailing Address - Country:US
Mailing Address - Phone:415-459-4235
Mailing Address - Fax:
Practice Address - Street 1:1030 SIR FRANCIS DRAKE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:KENTFIELD
Practice Address - State:CA
Practice Address - Zip Code:94904-1411
Practice Address - Country:US
Practice Address - Phone:415-459-4235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC29793106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist