person
Mr. Delton Wade De Vose, PHD,LPCS,CCS,BCTM
Professional Counselor in Martinez, Georgia
NPI 1194860759

Delton Wade De Vose is a Professional Counselor based in Martinez, GA and is specialized in Professional. Delton Wade De Vose practices in Martinez, GA and has the professional credentials of PHD,LPCS,CCS,BCTM. The NPI Number for Delton Wade De Vose is 1194860759 and holds a License No. 1658 (Georgia).

The current practice location address for Delton Wade De Vose is 4210 Columbia Rd Ste 11B, Martinez, GA and can be reached out via phone at 706-364-6576 and via fax at 888-445-2452.

Location: 4210 Columbia Rd Ste 11B, Martinez, GA, 30907-0443
person
Provider Profile Details
NPI Number
1194860759
Provider Name
Delton Wade De Vose
Credential
PHD,LPCS,CCS,BCTM
Provider Entity Type
Individual
Gender
Male
Address
4210 Columbia Rd Ste 11B, Martinez, GA, 30907-0443
Phone Number
706-364-6576
Fax Number
888-445-2452
Provider Enumeration Date
02/21/2007
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
3404922 01 BCBS
6103058 05 NC
institution
Provider Business Practice Location Address Details
Address
4210 Columbia Rd Ste 11B
City
State
Zip
30907-0443
Phone Number
706-364-6576
Fax Number
888-445-2452
person
Provider Business Mailing Address Details
Address
4210 Columbia Rd Ste 11B
City
State
Zip
30907-0443
Phone Number
706-364-6576
Fax Number
888-445-2452
person
Provider's Taxonomy Details 1
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Addiction (Substance Use Disorder)
Taxonomy
License No.
4985 (North Carolina)
Definition
Definition to come...
person
Provider's Taxonomy Details 2
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Professional
Taxonomy
License No.
1658 (North Carolina)
Definition
Definition to come...
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