Provider Demographics
NPI:1972050169
Name:DIRHAM, DEONNA CHRISTINE (LPCC-S)
Entity Type:Individual
Prefix:
First Name:DEONNA
Middle Name:CHRISTINE
Last Name:DIRHAM
Suffix:
Gender:F
Credentials:LPCC-S
Other - Prefix:
Other - First Name:DEONNA
Other - Middle Name:CHRISTINE
Other - Last Name:GREEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPCC-S
Mailing Address - Street 1:1867 W MARKET ST
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44313-6901
Mailing Address - Country:US
Mailing Address - Phone:330-812-7665
Mailing Address - Fax:
Practice Address - Street 1:1867 W MARKET ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44313-6901
Practice Address - Country:US
Practice Address - Phone:330-812-7665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-06
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.0008161-SUPV101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH227100Medicaid