Provider Demographics
NPI:1457886103
Name:FLEMING, GLERON DESHAE
Entity Type:Individual
Prefix:MR
First Name:GLERON
Middle Name:DESHAE
Last Name:FLEMING
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1655 RICHWOOD ROAD 1
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71202-6894
Mailing Address - Country:US
Mailing Address - Phone:318-436-8305
Mailing Address - Fax:
Practice Address - Street 1:1655 RICHWOOD ROAD 1
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71202-6894
Practice Address - Country:US
Practice Address - Phone:318-436-8305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-01
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health