Individual
MR. DELTON WADE DE VOSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD, LPCS, CCS, BCTM
Contact information
Practice address
4210 COLUMBIA RD STE 11B, MARTINEZ, GA 30907-0443
(706) 364-6576
(888) 445-2452
Mailing address
4210 COLUMBIA RD STE 11B, MARTINEZ, GA 30907-0443
(919) 937-5486
(888) 445-2452
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
1658
NC
101YP2500X
Professional Counselor
Primary
007674
GA
101YP2500X
Professional Counselor
4985
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3404922
BCBS
—
05
—
6103058
—
NC
Enumeration date
02/21/2007
Last updated
09/16/2020
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