Provider Demographics
NPI:1811697022
Name:DEJOURNETTE, DOUGLAS
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:
Last Name:DEJOURNETTE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2271 CHANDLER MILL RD
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27311-8777
Mailing Address - Country:US
Mailing Address - Phone:336-459-7310
Mailing Address - Fax:
Practice Address - Street 1:1405 S SCALES ST
Practice Address - Street 2:
Practice Address - City:REIDSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27320-5634
Practice Address - Country:US
Practice Address - Phone:336-280-9432
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-06
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10158103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC92-0318443OtherIRS