Provider Demographics
NPI:1497125462
Name:GREMILLION, DEANDERIA D (MA, LPC, NCC)
Entity Type:Individual
Prefix:MRS
First Name:DEANDERIA
Middle Name:D
Last Name:GREMILLION
Suffix:
Gender:F
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5519 BOULEVARD D ISLE
Mailing Address - Street 2:
Mailing Address - City:JARREAU
Mailing Address - State:LA
Mailing Address - Zip Code:70749-3121
Mailing Address - Country:US
Mailing Address - Phone:225-939-4787
Mailing Address - Fax:
Practice Address - Street 1:230 ROBERTS DR STE H
Practice Address - Street 2:
Practice Address - City:NEW ROADS
Practice Address - State:LA
Practice Address - Zip Code:70760-2661
Practice Address - Country:US
Practice Address - Phone:225-618-5959
Practice Address - Fax:225-238-8330
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-02
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
LA7735101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA16138376Medicaid