Provider Demographics
NPI:1609375278
Name:DEAN, DAWANNA KAYE
Entity Type:Individual
Prefix:MISS
First Name:DAWANNA
Middle Name:KAYE
Last Name:DEAN
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 1:1102 MCALLISTER ST
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-6050
Mailing Address - Country:US
Mailing Address - Phone:318-497-0271
Mailing Address - Fax:
Practice Address - Street 1:4951 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71203-6156
Practice Address - Country:US
Practice Address - Phone:318-340-1535
Practice Address - Fax:318-340-1539
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-08
Last Update Date:2018-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health