Provider Demographics
NPI:1457019945
Name:GEORGE, DENISHA
Entity Type:Individual
Prefix:
First Name:DENISHA
Middle Name:
Last Name:GEORGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3004 NW 130TH TER APT 353
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-3950
Mailing Address - Country:US
Mailing Address - Phone:757-655-7274
Mailing Address - Fax:775-392-1245
Practice Address - Street 1:4652 HAYGOOD RD STE C
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-5447
Practice Address - Country:US
Practice Address - Phone:757-655-7274
Practice Address - Fax:775-392-1245
Is Sole Proprietor?:No
Enumeration Date:2021-12-02
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician