Individual
DEIJAH WANNAMAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2324 YOUNTS RD, INDIAN TRAIL, NC 28079-8507
(704) 893-3607
Mailing address
7736 WATERFORD LAKES DRIVE, APARTMENT 1416, CHARLOTTE, NC 28210
(803) 800-4954
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
10/24/2024
Last updated
10/24/2024
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