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General NPI Number Information
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NPI Number | 1265140875
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Entity Type | Organization
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Legal Business Name | DEMA AGENCY CONSULTANTS LLC
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Dates
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Enumeration Date | 11/11/2022
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Last Update Date | 02/14/2024
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Provider Practice Location Address
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Address Line | 699 W RIALTO AVE UNIT B
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City | SAN BERNARDINO
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State | CA
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Zip | 92410-3327
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Country | US
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Telephone | 312-728-3509
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Fax | 312-312-7364
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Provider Business Mailing Address
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Address Line | 1074 PEACHTREE WALK NE UNIT B503
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City | ATLANTA
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State | GA
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Zip | 30309-3968
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Country | US
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Telephone | 630-880-2150
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Fax | 312-312-7364
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Authorized Official
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Title or Position | CEO
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Name | MRS. CASSANDRA GOVAN
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Credential |
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Telephone | 630-880-2150
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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