Provider Demographics
NPI:1265940597
Name:DEAN-EL, VONTIJA (LISW-S)
Entity type:Individual
Prefix:
First Name:VONTIJA
Middle Name:
Last Name:DEAN-EL
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:VONTIJA
Other - Middle Name:
Other - Last Name:DEAN-EL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LISW-S
Mailing Address - Street 1:1074 NASHVILLE DR APT 2018
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43240-1556
Mailing Address - Country:US
Mailing Address - Phone:614-323-7178
Mailing Address - Fax:
Practice Address - Street 1:1074 NASHVILLE DR APT 2018
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43240-1556
Practice Address - Country:US
Practice Address - Phone:614-323-7178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-22
Last Update Date:2018-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.1200702-SUPV104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker