De Vose, Delton Wade
De Vose, Delton Wade is an sole proprietor health care provider with primary practice located at 4210 Columbia Rd Ste 11B , Martinez GA 30907-0443. He recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), Behavioral Health & Social Service Providers / Professional. Behavioral Health & Social Service Providers / Professional is his primary health care specialty. De Vose, Delton Wade can be contacted via phone (706) 364-6576.Contact Information
Primary practice address
4210 Columbia Rd Ste 11B
Martinez GA 30907-0443
Phone: (706) 364-6576
Fax: (888) 445-2452
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) | 101YA0400X | 1658 | North Carolina |
| Behavioral Health & Social Service Providers / Professional | 101YP2500X | 4985 | North Carolina |
| Behavioral Health & Social Service Providers / Professional | 101YP2500X | 007674 | Georgia |
Profile Details
| NPI number | 1194860759 |
|---|---|
| LBN Legal business name | De Vose, Delton Wade |
| Credentials | PHD, LPCS, CCS, BCTM |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Feb 21st, 2007 |
| Last updated | Sep 16th, 2020 - about 4 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1194860759 | NPPES |
| Other | 3404922 | BCBS | |
| MEDICAID | 6103058 | BCBS |
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