Provider Demographics
NPI:1659991735
Name:JAMITH, DEANDREA
Entity Type:Individual
Prefix:
First Name:DEANDREA
Middle Name:
Last Name:JAMITH
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:PO BOX 682115
Mailing Address - Street 2:
Mailing Address - City:PRATTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36068-2115
Mailing Address - Country:US
Mailing Address - Phone:205-657-4618
Mailing Address - Fax:
Practice Address - Street 1:98 MOUNTAIN VIEW CT
Practice Address - Street 2:
Practice Address - City:MILLBROOK
Practice Address - State:AL
Practice Address - Zip Code:36054
Practice Address - Country:US
Practice Address - Phone:205-657-4618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-20
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3925101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor