Provider Demographics
NPI:1588357479
Name:SALLAWAY, DERYKAH MONIQUE (PHD)
Entity type:Individual
Prefix:
First Name:DERYKAH
Middle Name:MONIQUE
Last Name:SALLAWAY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:DERYKAH
Other - Middle Name:MONIQUE
Other - Last Name:SALLAWAY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD DERYKAH SALLAWAY
Mailing Address - Street 1:1266 ANGELIA DR SW
Mailing Address - Street 2:
Mailing Address - City:MABLETON
Mailing Address - State:GA
Mailing Address - Zip Code:30126-4808
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3260 POINTE PKWY STE 40
Practice Address - Street 2:
Practice Address - City:PEACHTREE CORNERS
Practice Address - State:GA
Practice Address - Zip Code:30092-3330
Practice Address - Country:US
Practice Address - Phone:800-398-2220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-29
Last Update Date:2023-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral