Provider Demographics
NPI:1104643790
Name:DEEL BEHAVIORAL HEALTH SERVICES
Entity type:Organization
Organization Name:DEEL BEHAVIORAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:ORBIA
Authorized Official - Last Name:DEEL
Authorized Official - Suffix:
Authorized Official - Credentials:AGPCNP / CLINPSYD
Authorized Official - Phone:864-304-5982
Mailing Address - Street 1:PO BOX 587
Mailing Address - Street 2:
Mailing Address - City:INMAN
Mailing Address - State:SC
Mailing Address - Zip Code:29349-0587
Mailing Address - Country:US
Mailing Address - Phone:864-304-5982
Mailing Address - Fax:828-570-5272
Practice Address - Street 1:165 STALLION RD STE A
Practice Address - Street 2:
Practice Address - City:INMAN
Practice Address - State:SC
Practice Address - Zip Code:29349-8511
Practice Address - Country:US
Practice Address - Phone:864-304-5982
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-24
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty