Provider Demographics
NPI:1083803092
Name:BOHANAN, DESEREE DEANN (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:DESEREE
Middle Name:DEANN
Last Name:BOHANAN
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1313 COLGATE DR
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-3904
Mailing Address - Country:US
Mailing Address - Phone:310-272-6193
Mailing Address - Fax:
Practice Address - Street 1:4001 LONG BEACH BLVD
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-2616
Practice Address - Country:US
Practice Address - Phone:510-226-6180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-16
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health