Provider Demographics
NPI:1457503575
Name:BOTKIN, DEJAYE (MA, LPC, NCC)
Entity Type:Individual
Prefix:PROF
First Name:DEJAYE
Middle Name:
Last Name:BOTKIN
Suffix:
Gender:F
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:DEJAYE
Other - Middle Name:
Other - Last Name:BOTKIN-RADIOTIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:101 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85281-0400
Mailing Address - Country:US
Mailing Address - Phone:203-609-1714
Mailing Address - Fax:
Practice Address - Street 1:101 W 5TH ST
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85281-0400
Practice Address - Country:US
Practice Address - Phone:203-609-1714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-21
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
37PC00326200101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional