Provider Demographics
NPI:1053853424
Name:WAUTHIER, DEBORAH (MSW/LSW, LCDCIII)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:WAUTHIER
Suffix:
Gender:F
Credentials:MSW/LSW, LCDCIII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11660 UPPER GILCHRIST RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:OH
Mailing Address - Zip Code:43050-9084
Mailing Address - Country:US
Mailing Address - Phone:740-392-2200
Mailing Address - Fax:
Practice Address - Street 1:11660 UPPER GILCHRIST RD
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050-9084
Practice Address - Country:US
Practice Address - Phone:740-392-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-16
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
OHS.22072711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)