Healthcare Provider Details

I. General information

NPI: 1114626256
Provider Name (Legal Business Name): DEEZYA JULIANNA MONROE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2023
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2360 W JOPPA RD
TIMONIUM MD
21093-4624
US

IV. Provider business mailing address

2360 W JOPPA RD STE 222
TIMONIUM MD
21093-4664
US

V. Phone/Fax

Practice location:
  • Phone: 555-555-5555
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: