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Individual
MRS. CANDIDA AMBER DAVENPORT
Active
Individual
MRS. CANDIDA AMBER DAVENPORT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LAC, LADC
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
1492
ND
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
303356
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
022581
BCBS ND PROVIDER NUMBER
ND
05
—
054519
—
ND
01
—
92OS7KI
BCBS MN PROVIDER NUMBER
MN
Enumeration date
07/02/2006
Last updated
06/24/2013
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