Provider Demographics
NPI:1417669979
Name:DELOACH, KARMECIA L'AIME (MED/ST)
Entity Type:Individual
Prefix:
First Name:KARMECIA
Middle Name:L'AIME
Last Name:DELOACH
Suffix:
Gender:F
Credentials:MED/ST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 STALWICK DR
Mailing Address - Street 2:
Mailing Address - City:POOLER
Mailing Address - State:GA
Mailing Address - Zip Code:31322-8254
Mailing Address - Country:US
Mailing Address - Phone:706-741-6576
Mailing Address - Fax:
Practice Address - Street 1:6944 HIGHWAY 85 STE F
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274-2960
Practice Address - Country:US
Practice Address - Phone:770-683-6946
Practice Address - Fax:770-683-6946
Is Sole Proprietor?:No
Enumeration Date:2022-12-15
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC009547101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health