Provider Demographics
NPI:1174139133
Name:D. W. DE VOSE & ASSOCIATES, LLC
Entity type:Organization
Organization Name:D. W. DE VOSE & ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DELTON
Authorized Official - Middle Name:
Authorized Official - Last Name:DE VOSE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LPC, CCS, BCTM
Authorized Official - Phone:706-364-6576
Mailing Address - Street 1:4210 COLUMBIA RD STE 11B
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907-0443
Mailing Address - Country:US
Mailing Address - Phone:706-364-6576
Mailing Address - Fax:888-445-2452
Practice Address - Street 1:4210 COLUMBIA RD STE 11B
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:GA
Practice Address - Zip Code:30907-0443
Practice Address - Country:US
Practice Address - Phone:706-364-6576
Practice Address - Fax:888-445-2452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-16
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use DisorderGroup - Multi-Specialty