person
Mrs. Candida Amber Davenport, LAC,LADC
Addiction (Substance Use Disorder) Counselor in Plymouth, Minnesota
NPI 1932138765

Candida Amber Davenport is an Addiction (Substance Use Disorder) Counselor based in Plymouth, MN and is specialized in Addiction (Substance Use Disorder). Candida Amber Davenport practices in Plymouth, MN and has the professional credentials of LAC,LADC. The NPI Number for Candida Amber Davenport is 1932138765 and holds a License No. 1492 (Minnesota).

The current practice location address for Candida Amber Davenport is 115 Forestview Ln N, Plymouth, MN and can be reached out via phone at 763-546-8008 and via fax at 763-546-7674. You can also correspond with Candida Amber Davenport through the mailing address at 115 FORESTVIEW LN N, PLYMOUTH, MN - 55441-5910 (mailing address contact number: 763-546-8008).

Location: 115 Forestview Ln N, Plymouth, MN, 55441-5910
person
Provider Profile Details
NPI Number
1932138765
Provider Name
Candida Amber Davenport
Credential
LAC,LADC
Provider Entity Type
Individual
Gender
Female
Address
115 Forestview Ln N, Plymouth, MN, 55441-5910
Phone Number
763-546-8008
Fax Number
763-546-7674
Provider Enumeration Date
07/02/2006
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
92OS7KI 01 MN BCBS MN PROVIDER NUMBER
054519 05 ND
022581 01 ND BCBS ND PROVIDER NUMBER
institution
Provider Business Practice Location Address Details
Address
115 Forestview Ln N
City
State
Zip
55441-5910
Phone Number
763-546-8008
Fax Number
763-546-7674
person
Provider Business Mailing Address Details
Address
115 Forestview Ln N
City
State
Zip
55441-5910
Phone Number
763-546-8008
Fax Number
763-546-7674
person
Provider's Taxonomy Details 1
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Addiction (Substance Use Disorder)
Taxonomy
License No.
1492 (North Dakota)
Definition
Definition to come...
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