Provider Demographics
NPI:1477195774
Name:CANTY, DATWON DESHAWN (MS, LCAS)
Entity Type:Individual
Prefix:
First Name:DATWON
Middle Name:DESHAWN
Last Name:CANTY
Suffix:
Gender:M
Credentials:MS, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:757 MILL RD
Mailing Address - Street 2:
Mailing Address - City:HAMLET
Mailing Address - State:NC
Mailing Address - Zip Code:28345-8841
Mailing Address - Country:US
Mailing Address - Phone:336-465-6036
Mailing Address - Fax:
Practice Address - Street 1:757 MILL RD
Practice Address - Street 2:
Practice Address - City:HAMLET
Practice Address - State:NC
Practice Address - Zip Code:28345-8841
Practice Address - Country:US
Practice Address - Phone:336-465-6036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-09
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC26041101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)