Individual
MR. DARRELL DEVONISH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CASAC-T
Contact information
Practice address
11630 SUTPHIN BLVD, JAMAICA, NY 11434-1527
(718) 322-2500
Mailing address
108 EDGECOMBE AVE, 1B, NEW YORK, NY 10030-1939
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
27920
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
27920
CASAC-T
NY
Enumeration date
01/17/2014
Last updated
01/17/2014
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