Provider Demographics
NPI:1780344937
Name:SPRATLEY, DAWNEISHA DESHAY
Entity type:Individual
Prefix:
First Name:DAWNEISHA
Middle Name:DESHAY
Last Name:SPRATLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6726 N 18TH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19126-2602
Mailing Address - Country:US
Mailing Address - Phone:267-331-6741
Mailing Address - Fax:
Practice Address - Street 1:6726 N 18TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19126-2602
Practice Address - Country:US
Practice Address - Phone:267-331-6741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-28
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC007907101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional