Provider Demographics
NPI:1275006041
Name:DENNIS, DEVRON SR (PHD)
Entity Type:Individual
Prefix:DR
First Name:DEVRON
Middle Name:
Last Name:DENNIS
Suffix:SR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 INNOVATION DR APT 4303
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-7702
Mailing Address - Country:US
Mailing Address - Phone:863-612-6071
Mailing Address - Fax:
Practice Address - Street 1:75 INNOVATION DR APT 4303
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-7702
Practice Address - Country:US
Practice Address - Phone:863-612-6071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-04
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral