Provider Demographics
NPI:1649940461
Name:PAINTER, DESHAWN RONDALE (MSW)
Entity type:Individual
Prefix:
First Name:DESHAWN
Middle Name:RONDALE
Last Name:PAINTER
Suffix:
Gender:
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2003 E NC HIGHWAY 54 STE C
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-2483
Mailing Address - Country:US
Mailing Address - Phone:919-682-5300
Mailing Address - Fax:
Practice Address - Street 1:2003 E NC HIGHWAY 54 STE C
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-2482
Practice Address - Country:US
Practice Address - Phone:919-682-5300
Practice Address - Fax:919-682-5322
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-14
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP016761251S00000X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No251S00000XAgenciesCommunity/Behavioral Health