Provider Demographics
NPI:1174168587
Name:DAVIDSON, JENNIFER HELEN (LMHC)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:HELEN
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 YACHT CLUB DR APT 17
Mailing Address - Street 2:
Mailing Address - City:NORTH PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33408-3934
Mailing Address - Country:US
Mailing Address - Phone:561-601-5645
Mailing Address - Fax:
Practice Address - Street 1:68 YACHT CLUB DR APT 17
Practice Address - Street 2:
Practice Address - City:NORTH PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33408-3934
Practice Address - Country:US
Practice Address - Phone:561-601-5645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-08
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL14581324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility