Provider Demographics
NPI:1801277710
Name:DENNIS, VEJA
Entity type:Individual
Prefix:
First Name:VEJA
Middle Name:
Last Name:DENNIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:VEJA
Other - Middle Name:
Other - Last Name:MYCO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2168 CREST WOOD DR
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30094-4795
Mailing Address - Country:US
Mailing Address - Phone:404-992-0192
Mailing Address - Fax:
Practice Address - Street 1:95 PARTRIDGE DR STE 105
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30016-1185
Practice Address - Country:US
Practice Address - Phone:678-905-1500
Practice Address - Fax:678-905-1337
Is Sole Proprietor?:No
Enumeration Date:2015-06-16
Last Update Date:2024-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1-23-65662103K00000X, 103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst