Provider Demographics
NPI:1083646988
Name:DAVIS, DEBORAH LYNN (LPCC, LMAC)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:LYNN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LPCC, LMAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2424 32ND AVE S
Mailing Address - Street 2:SUITE 202
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-6545
Mailing Address - Country:US
Mailing Address - Phone:701-746-6336
Mailing Address - Fax:701-772-1030
Practice Address - Street 1:2424 32ND AVE S
Practice Address - Street 2:SUITE 202
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-6545
Practice Address - Country:US
Practice Address - Phone:701-746-6336
Practice Address - Fax:701-772-1030
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1180101YA0400X
171M00000X
ND881-7-1-16-176101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND054519Medicaid
MN9G411DAOtherBCBS MN PROVIDER NUMBER
ND012197OtherBCBS ND PROVIDER NUMBER