Provider Demographics
NPI:1093063448
Name:DESHANNON, BRANDI LONJE
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:LONJE
Last Name:DESHANNON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10220 FOOTHILL BLVD
Mailing Address - Street 2:#5102
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-0343
Mailing Address - Country:US
Mailing Address - Phone:909-329-6602
Mailing Address - Fax:
Practice Address - Street 1:10220 FOOTHILL BLVD
Practice Address - Street 2:#5102
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-0343
Practice Address - Country:US
Practice Address - Phone:909-329-6602
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-16
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health