Davenport, Candida Amber

Davenport, Candida Amber is an individual health care provider with primary practice located at 115 Forestview Ln N , Plymouth MN 55441-5910. She recently has only one registered license in Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), which is considered as her primary health care specialty. Davenport, Candida Amber can be contacted via phone (763) 546-8008.

Contact Information

Primary practice address
115 Forestview Ln N Plymouth MN 55441-5910
Phone: (763) 546-8008
Fax: (763) 546-7674
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X 1492 North Dakota
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X 303356 Minnesota

Profile Details

NPI number 1932138765
LBN Legal business name Davenport, Candida Amber
Credentials LAC, LADC
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 2nd, 2006
Last updated Jun 24th, 2013 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1932138765 NPPES
Minnesota Other 92OS7KI BCBS MN PROVIDER NUMBER
Minnesota MEDICAID 054519 BCBS MN PROVIDER NUMBER
Minnesota Other 022581 BCBS MN PROVIDER NUMBER

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