Organization
DAVENPORT FAMILY SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JERMAINE DAVENPORT (CEO)
(828) 279-4443
Entity
Organization
Contact information
Practice address
3412 THISTLE BLOOM CT, CHARLOTTE, NC 28269-1309
(980) 384-8103
Mailing address
3412 THISTLE BLOOM CT, CHARLOTTE, NC 28269-1309
(980) 384-8103
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
310500000X
Mental Illness Intermediate Care Facility
—
—
311ZA0620X
Adult Care Home Facility
—
—
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
—
—
385H00000X
Respite Care
—
—
Other
Enumeration date
10/19/2023
Last updated
10/19/2023
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