Provider Demographics
NPI:1851655054
Name:NEWSOME, CHE DESHAUN (BA)
Entity Type:Individual
Prefix:MR
First Name:CHE
Middle Name:DESHAUN
Last Name:NEWSOME
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 1:4714 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90043-1454
Mailing Address - Country:US
Mailing Address - Phone:323-359-5503
Mailing Address - Fax:
Practice Address - Street 1:4714 2ND AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90043-1454
Practice Address - Country:US
Practice Address - Phone:323-359-5503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-02
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor