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NPI Code Detail

MEDICARE: DEANNA DENISE VELAZQUEZ LCMHCA, LCASA

MEDICARE: DEANNA DENISE VELAZQUEZ LCMHCA, LCASA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor
2101YP2500XProfessional Counselor
3101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1770007841
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEANNA DENISE VELAZQUEZ LCMHCA, LCASA
Provider Business Mailing Address
First Line : PO BOX 4003
Second Line :
City : GASTONIA
State : NC
Zip : 28054-0041
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 107 N SUMMEY ST
Second Line :
City : DALLAS
State : NC
Zip : 28034-1824
Country : US
Telephone Number : 704-865-3525
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/01/2017
Last Update Date : 04/15/2022

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