Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TA0700X | Adult Development & Aging Psychologist | 1963374 | DC |
NPI | 1659947885 |
---|---|
Provider Name | Deanetta Denise Thomas |
First Address | Washington, DC 20020-3238 |
Second Address | Washington, DC 20018-1923 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/05/2021 |
Last Update Date | 28/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
90867031 | (05) | DC |