Provider Demographics
NPI:1003429499
Name:DELANEY, DWAYNE LAMAR (BA-QMHP-C/A)
Entity Type:Individual
Prefix:MR
First Name:DWAYNE
Middle Name:LAMAR
Last Name:DELANEY
Suffix:
Gender:M
Credentials:BA-QMHP-C/A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19204 PERKINSON RD
Mailing Address - Street 2:
Mailing Address - City:JETERSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23083-2000
Mailing Address - Country:US
Mailing Address - Phone:804-513-4289
Mailing Address - Fax:
Practice Address - Street 1:19204 PERKINSON RD
Practice Address - Street 2:
Practice Address - City:JETERSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23083-2000
Practice Address - Country:US
Practice Address - Phone:804-513-4289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-26
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health