Provider Demographics
NPI:1093118101
Name:RANKIN, DEVON LAYSHENE
Entity type:Individual
Prefix:
First Name:DEVON
Middle Name:LAYSHENE
Last Name:RANKIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DEVON
Other - Middle Name:LAYSHENE
Other - Last Name:BESHEARS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2108 N ST STE 8531
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-5712
Mailing Address - Country:US
Mailing Address - Phone:925-378-5295
Mailing Address - Fax:
Practice Address - Street 1:710 BLACK DIAMOND ST # CA
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:CA
Practice Address - Zip Code:94565-2148
Practice Address - Country:US
Practice Address - Phone:925-378-5295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-02
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA85635106H00000X
CA123947106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist