Provider Demographics
NPI:1093473324
Name:DEDEAUX, BRIANNA CELINE
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:CELINE
Last Name:DEDEAUX
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 1:800 N WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-4832
Mailing Address - Country:US
Mailing Address - Phone:910-977-5020
Mailing Address - Fax:
Practice Address - Street 1:800 N WALNUT ST
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-4832
Practice Address - Country:US
Practice Address - Phone:910-739-3064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-03
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA17839101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health