Provider Demographics
NPI:1437686813
Name:DEWHURST, DEZIRA (BS, BCABA, LABA)
Entity type:Individual
Prefix:
First Name:DEZIRA
Middle Name:
Last Name:DEWHURST
Suffix:
Gender:F
Credentials:BS, BCABA, LABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7960 DONEGAN DR STE 217
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20109-8236
Mailing Address - Country:US
Mailing Address - Phone:703-479-6105
Mailing Address - Fax:
Practice Address - Street 1:7960 DONEGAN DR STE 217
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109-8236
Practice Address - Country:US
Practice Address - Phone:703-392-6166
Practice Address - Fax:703-392-6166
Is Sole Proprietor?:No
Enumeration Date:2017-05-17
Last Update Date:2025-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0134000336106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst