Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 61809 | TX |
NPI | 1003586595 |
---|---|
Provider Name | Jaquavia Lynn Demus |
First Address | Houston, TX 77053-3123 |
Second Address | Houston, TX 77053-3123 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2021 |
Last Update Date | 15/09/2021 |