Provider Demographics
NPI:1871058859
Name:DEIGH, DONNETTE
Entity type:Individual
Prefix:
First Name:DONNETTE
Middle Name:
Last Name:DEIGH
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 1:6915 BONNIE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-1844
Mailing Address - Country:US
Mailing Address - Phone:443-610-9926
Mailing Address - Fax:
Practice Address - Street 1:583 FREDERICK RD STE 6B
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-4697
Practice Address - Country:US
Practice Address - Phone:410-870-5615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-05
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP8209101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health