Provider Demographics
NPI:1649478611
Name:DELOATCH, DELLA REID (AAS,CCJP,CSAS)
Entity type:Individual
Prefix:MS
First Name:DELLA
Middle Name:REID
Last Name:DELOATCH
Suffix:
Gender:F
Credentials:AAS,CCJP,CSAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 948
Mailing Address - Street 2:
Mailing Address - City:RICH SQUARE
Mailing Address - State:NC
Mailing Address - Zip Code:27869-0948
Mailing Address - Country:US
Mailing Address - Phone:252-578-2741
Mailing Address - Fax:
Practice Address - Street 1:415 HOLLOMAN AVE E
Practice Address - Street 2:
Practice Address - City:AHOSKIE
Practice Address - State:NC
Practice Address - Zip Code:27910-2314
Practice Address - Country:US
Practice Address - Phone:252-578-2741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator