Provider Demographics
NPI:1639354749
Name:DESONIA, ANITA B (MS, LMHC)
Entity Type:Individual
Prefix:MRS
First Name:ANITA
Middle Name:B
Last Name:DESONIA
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2682 CHAPMAN DR
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-4914
Mailing Address - Country:US
Mailing Address - Phone:850-215-6230
Mailing Address - Fax:859-215-6235
Practice Address - Street 1:2682 CHAPMAN DR
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4914
Practice Address - Country:US
Practice Address - Phone:850-215-6230
Practice Address - Fax:859-215-6235
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-08
Last Update Date:2010-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH9274101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health