NPIMap

Organization Active NPI

D. W. de Vose & Associates, LLC

  • Mental Health Counselor
  • Martinez, GA
National Provider Identifier
1174139133
Registry record updated Sep 16, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
D. W. DE VOSE & ASSOCIATES, LLC
Practice address
4210 Columbia Rd Ste 11B
Martinez, GA 30907-0443
Phone
(706) 364-6576
Fax
(888) 445-2452
NPI assigned
Sep 16, 2020
Last updated
Sep 16, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 16, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Delton De Vose, PHD, LPC, CCS, BCTMNPI 1194860759
Title
Executive Clinical Director
Phone
(706) 364-6576

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X NU
Mental Health Counselor 101YM0800X NU Primary

Addresses

Primary practice location

4210 Columbia Rd Ste 11B
Martinez, GA 30907-0443

Mailing address

4210 Columbia Rd Ste 11B
Martinez, GA 30907-0443
Phone (706) 364-6576

National Provider Directory

National Provider Directory

Locations

4210 Columbia Rd
Ste 11B
Martinez, GA 30907
Phone (706) 364-6576

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1600214400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1600214400000",
    "number": "1174139133",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4210 COLUMBIA RD STE 11B",
            "city": "MARTINEZ",
            "state": "GA",
            "postal_code": "309070443",
            "telephone_number": "706-364-6576",
            "fax_number": "888-445-2452"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4210 COLUMBIA RD STE 11B",
            "city": "MARTINEZ",
            "state": "GA",
            "postal_code": "309070443",
            "telephone_number": "706-364-6576",
            "fax_number": "888-445-2452"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "D. W. DE VOSE & ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-16",
        "last_updated": "2020-09-16",
        "certification_date": "2020-09-16",
        "status": "A",
        "authorized_official_last_name": "DE VOSE",
        "authorized_official_first_name": "DELTON",
        "authorized_official_title_or_position": "EXECUTIVE CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "706-364-6576",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD, LPC, CCS, BCTM"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Martinez, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.