Provider Demographics
NPI:1871030908
Name:OWENS, DEANDRIA ANTONEASE (LPC, NCC, MAC)
Entity Type:Individual
Prefix:MS
First Name:DEANDRIA
Middle Name:ANTONEASE
Last Name:OWENS
Suffix:
Gender:F
Credentials:LPC, NCC, MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 DALRYMPLE RD
Mailing Address - Street 2:APT. C-4
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-1446
Mailing Address - Country:US
Mailing Address - Phone:404-433-6414
Mailing Address - Fax:
Practice Address - Street 1:750 DALRYMPLE RD
Practice Address - Street 2:APT. C-4
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-1446
Practice Address - Country:US
Practice Address - Phone:404-433-6414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-26
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA510199101YA0400X
GALPC008011101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)