Provider Demographics
NPI:1306495817
Name:DELOACH, CHENISE DEVONNE
Entity type:Individual
Prefix:MRS
First Name:CHENISE
Middle Name:DEVONNE
Last Name:DELOACH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7400 BEAUFONT SPRINGS DR STE 300
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23225-5519
Mailing Address - Country:US
Mailing Address - Phone:804-322-7188
Mailing Address - Fax:
Practice Address - Street 1:7400 BEAUFONT SPRINGS DR STE 300
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23225-5519
Practice Address - Country:US
Practice Address - Phone:804-322-7188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-06
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701008607101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty