Provider Demographics
NPI:1992682181
Name:CANTY, DE VON DEJARNETTE
Entity type:Individual
Prefix:
First Name:DE VON
Middle Name:DEJARNETTE
Last Name:CANTY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DE VON
Other - Middle Name:DEJARNETTE
Other - Last Name:REED
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3124 E 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43219-3786
Mailing Address - Country:US
Mailing Address - Phone:330-774-2579
Mailing Address - Fax:
Practice Address - Street 1:464 E MAIN ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-5364
Practice Address - Country:US
Practice Address - Phone:614-353-6159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-19
Last Update Date:2025-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty