Provider Demographics
NPI:1013783844
Name:DEAS-DAVIS, DA SHANDA (LPC)
Entity Type:Individual
Prefix:
First Name:DA SHANDA
Middle Name:
Last Name:DEAS-DAVIS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2711 ALAMOCITOS CREEK DR
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76549-5470
Mailing Address - Country:US
Mailing Address - Phone:254-371-0056
Mailing Address - Fax:
Practice Address - Street 1:2711 ALAMOCITOS CREEK DR
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76549-5470
Practice Address - Country:US
Practice Address - Phone:254-371-0056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-04
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX84627101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health