Provider Demographics
NPI:1730694027
Name:DEICHERT, DRAKIRAH L
Entity type:Individual
Prefix:
First Name:DRAKIRAH
Middle Name:L
Last Name:DEICHERT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DRAKIRAH
Other - Middle Name:L
Other - Last Name:GLENN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:888 N ALAMEDA ST APT 239E
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90012-4291
Mailing Address - Country:US
Mailing Address - Phone:763-354-0447
Mailing Address - Fax:
Practice Address - Street 1:2025 E 7TH ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-4590
Practice Address - Country:US
Practice Address - Phone:562-284-0108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-07
Last Update Date:2025-05-06
Deactivation Date:2021-05-02
Deactivation Code:
Reactivation Date:2025-01-10
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No172V00000XOther Service ProvidersCommunity Health Worker