Provider Demographics
NPI:1285471367
Name:DEWANOU, TRYPHENE JESUKEDE (LCMHCA)
Entity type:Individual
Prefix:
First Name:TRYPHENE
Middle Name:JESUKEDE
Last Name:DEWANOU
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5318 NC HIGHWAY 55 STE 206
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-9660
Mailing Address - Country:US
Mailing Address - Phone:919-912-5599
Mailing Address - Fax:
Practice Address - Street 1:5318 NC HIGHWAY 55 STE 206
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-9660
Practice Address - Country:US
Practice Address - Phone:919-912-5599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-15
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA20271101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health