Provider Demographics
NPI:1366554792
Name:DAVENPORT, LLOYD L (MSSW,ACSW)
Entity type:Individual
Prefix:
First Name:LLOYD
Middle Name:L
Last Name:DAVENPORT
Suffix:
Gender:M
Credentials:MSSW,ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 324
Mailing Address - Street 2:
Mailing Address - City:BRUNDIDGE
Mailing Address - State:AL
Mailing Address - Zip Code:36010-0324
Mailing Address - Country:US
Mailing Address - Phone:334-735-3545
Mailing Address - Fax:
Practice Address - Street 1:2400 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:TUSKEGEE
Practice Address - State:AL
Practice Address - Zip Code:36083-5001
Practice Address - Country:US
Practice Address - Phone:334-727-0550
Practice Address - Fax:334-725-2502
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical