Provider Demographics
NPI:1275244626
Name:DEVAN, EVERETTE (BEHAVIOR' TECHNICIAN)
Entity Type:Individual
Prefix:
First Name:EVERETTE
Middle Name:
Last Name:DEVAN
Suffix:
Gender:M
Credentials:BEHAVIOR' TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 THROWER LN
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-6284
Mailing Address - Country:US
Mailing Address - Phone:602-503-3827
Mailing Address - Fax:
Practice Address - Street 1:124 THROWER LN
Practice Address - Street 2:
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529-6284
Practice Address - Country:US
Practice Address - Phone:602-503-3827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-07
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician