Provider Demographics
NPI:1073891859
Name:WHITFIELD, DEBRA RENADE
Entity Type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:RENADE
Last Name:WHITFIELD
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 1:61 RICHARDSON DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89015-5413
Mailing Address - Country:US
Mailing Address - Phone:702-818-0247
Mailing Address - Fax:
Practice Address - Street 1:2349 RENAISSANCE DR
Practice Address - Street 2:SUITE A
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-6191
Practice Address - Country:US
Practice Address - Phone:702-739-7716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-28
Last Update Date:2011-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst