Individual
JOHN RUSSELL DAVENPORT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPCA
Contact information
Practice address
635 COX RD, SUITE B, GASTONIA, NC 28054-3424
(704) 691-7561
Mailing address
635 COX RD, SUITE B, GASTONIA, NC 28054-3424
(704) 691-7561
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
A11964
NC
Other
Enumeration date
11/13/2015
Last updated
11/13/2015
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