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:
Health care specialties
| Specialty | Code | License # | 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 12 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| 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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