Healthcare Provider Details

I. General information

NPI: 1861132573
Provider Name (Legal Business Name): DR. DEQUISHA LATRICE-LANG WEATHERSPOON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2022
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21101 DALE EVANS PKWY
APPLE VALLEY CA
92307-9356
US

IV. Provider business mailing address

21101 DALE EVANS PKWY
APPLE VALLEY CA
92307-9356
US

V. Phone/Fax

Practice location:
  • Phone: 760-221-8989
  • Fax:
Mailing address:
  • Phone: 760-221-8989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: