Provider Demographics
NPI:1356841902
Name:WEST, DEANDRE DEVELLE (RSW)
Entity Type:Individual
Prefix:
First Name:DEANDRE
Middle Name:DEVELLE
Last Name:WEST
Suffix:
Gender:M
Credentials:RSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61333 HIGHWAY 11 APT B208
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-5443
Mailing Address - Country:US
Mailing Address - Phone:985-288-9671
Mailing Address - Fax:
Practice Address - Street 1:2500 MAITLAND CENTER PKWY STE 250
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-4174
Practice Address - Country:US
Practice Address - Phone:407-351-7080
Practice Address - Fax:866-244-5539
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-20
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator