Provider Demographics
NPI:1255642823
Name:DERONJA, JOSEPHINE REDWINE (MED, LPC, NCC)
Entity type:Individual
Prefix:MRS
First Name:JOSEPHINE
Middle Name:REDWINE
Last Name:DERONJA
Suffix:
Gender:F
Credentials:MED, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:864 W MORGAN ST
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27603-1614
Mailing Address - Country:US
Mailing Address - Phone:919-743-6140
Mailing Address - Fax:919-743-6143
Practice Address - Street 1:864 W MORGAN ST
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27603-1614
Practice Address - Country:US
Practice Address - Phone:919-743-6140
Practice Address - Fax:919-743-6143
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-29
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7062101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional