Provider Demographics
NPI:1043459837
Name:ALLEN, DEBORAH A (LISAC)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:A
Last Name:ALLEN
Suffix:
Gender:F
Credentials:LISAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2073 N WILDFLOWER LN
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85222-6305
Mailing Address - Country:US
Mailing Address - Phone:520-836-1675
Mailing Address - Fax:520-421-1969
Practice Address - Street 1:120 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85222-4820
Practice Address - Country:US
Practice Address - Phone:520-836-1675
Practice Address - Fax:520-421-1969
Is Sole Proprietor?:No
Enumeration Date:2009-02-18
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC-10317101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZLISAC-10317OtherLISAC