Provider Demographics
NPI:1861008609
Name:MESANKO, DEVIN CHRISTOPHER (LAC)
Entity Type:Individual
Prefix:
First Name:DEVIN
Middle Name:CHRISTOPHER
Last Name:MESANKO
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 HYERS ST STE 3
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-7465
Mailing Address - Country:US
Mailing Address - Phone:732-281-2060
Mailing Address - Fax:732-281-6969
Practice Address - Street 1:52 HYERS ST STE 3
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-7465
Practice Address - Country:US
Practice Address - Phone:732-281-2060
Practice Address - Fax:732-281-6969
Is Sole Proprietor?:No
Enumeration Date:2020-09-17
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00434200101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional