Individual
DEIDRA DEWITT I
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
107 S HIGH ST, ANTLERS, OK 74523-3818
(580) 298-2830
Mailing address
107 S HIGH ST, ANTLERS, OK 74523-3818
(580) 298-2830
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100744370
—
OK
Enumeration date
11/15/2016
Last updated
11/15/2016
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