Provider Demographics
NPI:1548627482
Name:DEEYAA, BLESSING
Entity type:Individual
Prefix:
First Name:BLESSING
Middle Name:
Last Name:DEEYAA
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 1:255 GRIMES RD
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-6725
Mailing Address - Country:US
Mailing Address - Phone:678-366-6050
Mailing Address - Fax:678-366-6051
Practice Address - Street 1:255 GRIMES RD
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-6725
Practice Address - Country:US
Practice Address - Phone:678-366-6050
Practice Address - Fax:678-366-6051
Is Sole Proprietor?:No
Enumeration Date:2016-01-22
Last Update Date:2016-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACN0028888549101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health