Provider Demographics
NPI:1902411242
Name:SINGLETON, DEJEANAI
Entity Type:Individual
Prefix:
First Name:DEJEANAI
Middle Name:
Last Name:SINGLETON
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 1:304 15TH ST NE STE B
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44714-2523
Mailing Address - Country:US
Mailing Address - Phone:234-804-3008
Mailing Address - Fax:234-804-3024
Practice Address - Street 1:304 15TH ST NE STE B
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44714-2523
Practice Address - Country:US
Practice Address - Phone:234-804-3008
Practice Address - Fax:234-804-3024
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-14
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)