Provider Demographics
NPI:1699590810
Name:WINSLOW, DEANNAH MARIA (APCC6301)
Entity type:Individual
Prefix:
First Name:DEANNAH
Middle Name:MARIA
Last Name:WINSLOW
Suffix:
Gender:F
Credentials:APCC6301
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:686 E MILL ST
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92415-0649
Mailing Address - Country:US
Mailing Address - Phone:909-798-8580
Mailing Address - Fax:909-798-8575
Practice Address - Street 1:686 E MILL ST
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92415-0647
Practice Address - Country:US
Practice Address - Phone:909-798-8580
Practice Address - Fax:909-798-8575
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-21
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6301101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health