Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XM0800X | Mental Health | 0119-008189 | VA |
NPI | 1972164507 |
---|---|
Provider Name | Dr. Deanna Rachelle Dambrose |
First Address | Chesterfield, VA 23838-4235 |
Second Address | Chesterfield, VA 23838-4235 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2019 |
Last Update Date | 25/06/2019 |