Provider Demographics
NPI:1609680529
Name:DEVEREAUX, WILLIE RENARD (SOCIAL WORKER)
Entity type:Individual
Prefix:
First Name:WILLIE
Middle Name:RENARD
Last Name:DEVEREAUX
Suffix:
Gender:M
Credentials:SOCIAL WORKER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8012 LEITH CT
Mailing Address - Street 2:
Mailing Address - City:FORT CAVAZOS
Mailing Address - State:TX
Mailing Address - Zip Code:76544-1792
Mailing Address - Country:US
Mailing Address - Phone:706-577-7248
Mailing Address - Fax:
Practice Address - Street 1:8012 LEITH CT
Practice Address - Street 2:
Practice Address - City:FORT CAVAZOS
Practice Address - State:TX
Practice Address - Zip Code:76544-1792
Practice Address - Country:US
Practice Address - Phone:706-577-7248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-03
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA17842104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker