Provider Demographics
NPI:1871304121
Name:LANDRUM, DEON
Entity type:Individual
Prefix:
First Name:DEON
Middle Name:
Last Name:LANDRUM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24253 ALYDAR LOOP
Mailing Address - Street 2:
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-0330
Mailing Address - Country:US
Mailing Address - Phone:251-235-2531
Mailing Address - Fax:
Practice Address - Street 1:3100 COTTAGE HILL RD STE 400
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36606-2913
Practice Address - Country:US
Practice Address - Phone:251-235-2531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-16
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician