Provider Demographics
NPI:1053547992
Name:DEANDA, TRAYCE B
Entity type:Individual
Prefix:
First Name:TRAYCE
Middle Name:B
Last Name:DEANDA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2718 WESLEY ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75401-4121
Mailing Address - Country:US
Mailing Address - Phone:903-455-9090
Mailing Address - Fax:
Practice Address - Street 1:2718 WESLEY ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75401-4121
Practice Address - Country:US
Practice Address - Phone:903-455-9090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-05
Last Update Date:2009-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker