Provider Demographics
NPI:1558029843
Name:DEVEREUX, CAROLYN MONIQUE
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:MONIQUE
Last Name:DEVEREUX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 1300 BOX 611
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AA
Mailing Address - Zip Code:34042-0007
Mailing Address - Country:US
Mailing Address - Phone:910-949-6476
Mailing Address - Fax:
Practice Address - Street 1:PSC 1300
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AA
Practice Address - Zip Code:34042-0007
Practice Address - Country:US
Practice Address - Phone:910-949-6476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-03
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPCC.001758101YM0800X
WA61256334101YM0800X
FLIMH19769101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health