Provider Demographics
NPI:1013532118
Name:KNIGHT, DENNIESHA ANDRENE
Entity type:Individual
Prefix:
First Name:DENNIESHA
Middle Name:ANDRENE
Last Name:KNIGHT
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 1:5534 OLD NATIONAL HWY STE 150
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30349-3274
Mailing Address - Country:US
Mailing Address - Phone:703-348-9174
Mailing Address - Fax:404-529-4473
Practice Address - Street 1:5534 OLD NATIONAL HWY STE 150
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:GA
Practice Address - Zip Code:30349-3274
Practice Address - Country:US
Practice Address - Phone:470-334-8917
Practice Address - Fax:404-529-4473
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-15
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC011684101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health