Provider Demographics
NPI:1053899187
Name:LONDON, DAPHNE
Entity type:Individual
Prefix:
First Name:DAPHNE
Middle Name:
Last Name:LONDON
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 1:1325 AIRMOTIVE WAY STE 260
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-3284
Mailing Address - Country:US
Mailing Address - Phone:775-870-0943
Mailing Address - Fax:775-409-4368
Practice Address - Street 1:1325 AIRMOTIVE WAY STE 260
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502
Practice Address - Country:US
Practice Address - Phone:775-870-0943
Practice Address - Fax:775-409-4368
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-31
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst