Provider Demographics
NPI:1003400300
Name:IVY, DEBBIE S
Entity Type:Individual
Prefix:
First Name:DEBBIE
Middle Name:S
Last Name:IVY
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 1:2920 CHAPEL HILL RD APT 74B
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-3757
Mailing Address - Country:US
Mailing Address - Phone:919-904-1807
Mailing Address - Fax:
Practice Address - Street 1:2920 CHAPEL HILL RD APT 74B
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-3757
Practice Address - Country:US
Practice Address - Phone:919-904-1807
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-26
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician