Provider Demographics
NPI:1023847191
Name:DEDE, BREANNA ANN (PHD)
Entity type:Individual
Prefix:DR
First Name:BREANNA
Middle Name:ANN
Last Name:DEDE
Suffix:
Gender:
Credentials:PHD
Other - Prefix:DR
Other - First Name:BREANNA
Other - Middle Name:
Other - Last Name:DEDE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:2276 JOLLAY ST
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-6855
Mailing Address - Country:US
Mailing Address - Phone:352-219-7520
Mailing Address - Fax:
Practice Address - Street 1:2276 JOLLAY ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27703-6855
Practice Address - Country:US
Practice Address - Phone:352-219-7520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-29
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103584103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical