Provider Demographics
NPI:1346063104
Name:DUBOIS, DEIDRE
Entity type:Individual
Prefix:
First Name:DEIDRE
Middle Name:
Last Name:DUBOIS
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 1:4031 ESTATE LA GRANDE PRINCESSE STE 34
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSTED
Mailing Address - State:VI
Mailing Address - Zip Code:00820-5213
Mailing Address - Country:US
Mailing Address - Phone:340-473-9502
Mailing Address - Fax:
Practice Address - Street 1:4031 ESTATE LA GRANDE PRINCESSE STE 34
Practice Address - Street 2:
Practice Address - City:CHRISTIANSTED
Practice Address - State:VI
Practice Address - Zip Code:00820-5213
Practice Address - Country:US
Practice Address - Phone:340-473-9502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-31
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health