Provider Demographics
NPI:1811774078
Name:WINSTON, DENASIA TASHAE
Entity type:Individual
Prefix:
First Name:DENASIA
Middle Name:TASHAE
Last Name:WINSTON
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 1:110 LOWES BLVD UNIT A
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76542-6782
Mailing Address - Country:US
Mailing Address - Phone:309-218-6778
Mailing Address - Fax:
Practice Address - Street 1:3106 S W S YOUNG DR STE 105
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76542-2007
Practice Address - Country:US
Practice Address - Phone:325-450-5042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-12
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician