Provider Demographics
NPI:1598507774
Name:DEASY, DELRESHA NEGAIL
Entity type:Individual
Prefix:MRS
First Name:DELRESHA
Middle Name:NEGAIL
Last Name:DEASY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DELRESHA
Other - Middle Name:NEGAIL
Other - Last Name:BRADFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:120 NE 136TH AVE STE 220
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684-6951
Mailing Address - Country:US
Mailing Address - Phone:360-952-7060
Mailing Address - Fax:
Practice Address - Street 1:120 NE 136TH AVE STE 220
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-6951
Practice Address - Country:US
Practice Address - Phone:360-952-7060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-10
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician