Provider Demographics
NPI:1023844867
Name:MASTERS, DAVEANNA JOELLA
Entity type:Individual
Prefix:
First Name:DAVEANNA
Middle Name:JOELLA
Last Name:MASTERS
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 1:912 21ST ST APT B
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:WV
Mailing Address - Zip Code:26105-1318
Mailing Address - Country:US
Mailing Address - Phone:810-252-2494
Mailing Address - Fax:
Practice Address - Street 1:912 21ST ST APT B
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:WV
Practice Address - Zip Code:26105-1318
Practice Address - Country:US
Practice Address - Phone:810-252-2494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-09
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH189807101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)