Provider Demographics
NPI:1609625698
Name:WEATHERSPOON, DONYAH SHAMAYNE
Entity type:Individual
Prefix:
First Name:DONYAH
Middle Name:SHAMAYNE
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 1:7410 BLUEBONNET BLVD APT 1004S
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-1672
Mailing Address - Country:US
Mailing Address - Phone:678-733-2818
Mailing Address - Fax:
Practice Address - Street 1:7410 BLUEBONNET BLVD APT 1004S
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-1672
Practice Address - Country:US
Practice Address - Phone:678-733-2818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-14
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician