Provider Demographics
NPI:1467696864
Name:METZ, DERONDA DELPHINE (LCSW)
Entity Type:Individual
Prefix:MISS
First Name:DERONDA
Middle Name:DELPHINE
Last Name:METZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1614 FLYNWOOD DR APT C
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-3873
Mailing Address - Country:US
Mailing Address - Phone:704-910-1902
Mailing Address - Fax:
Practice Address - Street 1:1614 FLYNWOOD DR APT C
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205-3873
Practice Address - Country:US
Practice Address - Phone:704-910-1902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-29
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0062121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical