Provider Demographics
NPI:1477626471
Name:DERAMUS, MISTY MCCANTS (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MISTY
Middle Name:MCCANTS
Last Name:DERAMUS
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 1:116 WILKERSON AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35756-4280
Mailing Address - Country:US
Mailing Address - Phone:256-490-4443
Mailing Address - Fax:
Practice Address - Street 1:116 WILKERSON AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35756-4280
Practice Address - Country:US
Practice Address - Phone:256-490-4443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3635B104100000X
AL2405C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker