Healthcare Provider Details

I. General information

NPI: 1164031811
Provider Name (Legal Business Name): DESHANAE MICHELLE MEADERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2020
Last Update Date: 06/05/2025
Certification Date: 06/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2742 LORRING DR APT 204
DISTRICT HEIGHTS MD
20747-3434
US

IV. Provider business mailing address

2742 LORRING DR APT 204
DISTRICT HEIGHTS MD
20747-3434
US

V. Phone/Fax

Practice location:
  • Phone: 980-318-0542
  • Fax:
Mailing address:
  • Phone: 980-318-0542
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLGPC20001831
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: