Healthcare Provider Details

I. General information

NPI: 1275006041
Provider Name (Legal Business Name): DEVRON DENNIS SR. PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2019
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

243 KEATON CT
SPARTANBURG SC
29301-2770
US

IV. Provider business mailing address

243 KEATON CT
SPARTANBURG SC
29301-2770
US

V. Phone/Fax

Practice location:
  • Phone: 864-747-4613
  • Fax:
Mailing address:
  • Phone: 864-747-4613
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: