| Full Name | |
|---|---|
| Speciality | Psychologist - Clinical |
| Location | 1608 Oak St, Sarasota, Florida |
| Authorized Official Name and Position | Charles Robert Davenport (MANAGING MEMBER) |
| Authorized Official Contact | 9413211971 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1608 Oak St # 1608 Sarasota FL 34236-7517 Ph: (941) 321-1971 | 1608 Oak St Sarasota FL 34236-7517 Ph: (941) 321-1971 |
| NPI Number | 1063797504 |
|---|---|
| Provider Enumeration Date | 10/16/2011 |
| Last Update Date | 06/10/2021 |
| Certification Date | 06/10/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063797504 | NPI | - | NPPES |
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