Provider Demographics
NPI:1508257460
Name:DEMOSS, JAMES DARRELL III (LCSW)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:DARRELL
Last Name:DEMOSS
Suffix:III
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 AVON CT
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70461-4908
Mailing Address - Country:US
Mailing Address - Phone:985-774-3781
Mailing Address - Fax:
Practice Address - Street 1:102 AVON CT
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70461-4908
Practice Address - Country:US
Practice Address - Phone:985-774-3781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-13
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA114151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical