Provider Demographics
NPI:1861132573
Name:WEATHERSPOON, DEQUISHA LATRICE-LANG
Entity type:Individual
Prefix:DR
First Name:DEQUISHA
Middle Name:LATRICE-LANG
Last Name:WEATHERSPOON
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 1:21101 DALE EVANS PKWY
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-9356
Mailing Address - Country:US
Mailing Address - Phone:760-221-8989
Mailing Address - Fax:
Practice Address - Street 1:21101 DALE EVANS PKWY
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-9356
Practice Address - Country:US
Practice Address - Phone:760-221-8989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-30
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106E00000X
CA102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst