Provider Demographics
NPI:1346525268
Name:FORD, DESHAY DAVID (COUNSELOR)
Entity Type:Individual
Prefix:
First Name:DESHAY
Middle Name:DAVID
Last Name:FORD
Suffix:
Gender:M
Credentials:COUNSELOR
Other - Prefix:MR
Other - First Name:DESHAY
Other - Middle Name:DAVID
Other - Last Name:FORD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:COUNSELOR
Mailing Address - Street 1:1710 ONEIDA PL
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93030-8774
Mailing Address - Country:US
Mailing Address - Phone:805-351-5454
Mailing Address - Fax:
Practice Address - Street 1:1710 ONEIDA PL
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-8774
Practice Address - Country:US
Practice Address - Phone:805-351-5454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-12
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA101YA0400XMedicaid