Provider Demographics
NPI:1801587878
Name:NEWSOME, DEZEREE LASHAY
Entity type:Individual
Prefix:
First Name:DEZEREE
Middle Name:LASHAY
Last Name:NEWSOME
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 1:316 GUNNELL BR
Mailing Address - Street 2:
Mailing Address - City:BANNER
Mailing Address - State:KY
Mailing Address - Zip Code:41603-9087
Mailing Address - Country:US
Mailing Address - Phone:606-226-7269
Mailing Address - Fax:
Practice Address - Street 1:316 GUNNELL BR
Practice Address - Street 2:
Practice Address - City:BANNER
Practice Address - State:KY
Practice Address - Zip Code:41603-9087
Practice Address - Country:US
Practice Address - Phone:606-226-7269
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-18
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool