Provider Demographics
NPI:1235841172
Name:VINCENT, DE'ANNA JONNAI
Entity Type:Individual
Prefix:
First Name:DE'ANNA
Middle Name:JONNAI
Last Name:VINCENT
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:PO BOX 90062
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27675-0062
Mailing Address - Country:US
Mailing Address - Phone:919-638-9663
Mailing Address - Fax:
Practice Address - Street 1:740 BIG TWIG LN
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27703-3391
Practice Address - Country:US
Practice Address - Phone:919-638-9663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-22
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician