Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | 080774 | OH |
N | 101YP1600X | Pastoral Counselor | ORDAINED | OH |
Y | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 080774 | OH |
NPI | 1356615371 |
---|---|
Provider Name | Mrs. Debra Denise Deblanc |
First Address | Dayton, OH 45417-3813 |
Second Address | Dayton, OH 45417-3813 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2012 |
Last Update Date | 28/05/2012 |