Provider Demographics
NPI:1851623656
Name:NEWSON, DEYANTAE GILBERT (BA)
Entity Type:Individual
Prefix:
First Name:DEYANTAE
Middle Name:GILBERT
Last Name:NEWSON
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5245 MACARTHUR BLVD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94619-3448
Mailing Address - Country:US
Mailing Address - Phone:510-225-5419
Mailing Address - Fax:
Practice Address - Street 1:5245 MACARTHUR BLVD
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94619-3448
Practice Address - Country:US
Practice Address - Phone:510-225-5419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-03
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor