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Organization
TYRA DAVENPORT LLC
Active
Organization
TYRA DAVENPORT LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TYRA DAVENPORT LPC (PROFESSIONAL COUNSELOR)
(336) 686-3226
Entity
Organization
Contact information
Practice address
4004 N CHURCH ST, GREENSBORO, NC 27455-2624
(336) 686-3226
Mailing address
PO BOX 29221, GREENSBORO, NC 27429-9221
(336) 686-3226
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
03/12/2012
Last updated
03/12/2012
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