Provider Demographics
NPI:1003998311
Name:ENG, DEBRA LEIGH (LCSW)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:LEIGH
Last Name:ENG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7105 EASTRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27539-9745
Mailing Address - Country:US
Mailing Address - Phone:919-491-3644
Mailing Address - Fax:919-890-0071
Practice Address - Street 1:8382 SIX FORKS RD STE 104
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-5080
Practice Address - Country:US
Practice Address - Phone:919-764-4769
Practice Address - Fax:919-890-0071
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0047891041C0700X
NC902101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2873503AOtherMEDICARE PTAN
NC6003424Medicaid
NC2873503Medicare ID - Type Unspecified