Provider Demographics
NPI:1205580826
Name:FINN, DESHANNA
Entity type:Individual
Prefix:
First Name:DESHANNA
Middle Name:
Last Name:FINN
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 1:552 E CARSON ST STE 104
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90745-2897
Mailing Address - Country:US
Mailing Address - Phone:310-365-2294
Mailing Address - Fax:
Practice Address - Street 1:1325 E COOLEY DR STE 106
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-3966
Practice Address - Country:US
Practice Address - Phone:909-492-0573
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-11
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA122056106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist