Provider Demographics
NPI:1083648562
Name:COTTER, DEBRA L (LSW, LPCC-S, LICDC)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:L
Last Name:COTTER
Suffix:
Gender:F
Credentials:LSW, LPCC-S, LICDC
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:L
Other - Last Name:BECKERT-COTTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPCC-S
Mailing Address - Street 1:4464 S DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45005-5464
Mailing Address - Country:US
Mailing Address - Phone:513-649-8008
Mailing Address - Fax:513-649-8004
Practice Address - Street 1:4464 S DIXIE HWY
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45005-5464
Practice Address - Country:US
Practice Address - Phone:513-649-8008
Practice Address - Fax:513-649-8004
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLICDC.981315101YA0400X
OHS.0023468104100000X
OHE.0003303-SUPV101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000075727OtherANTHEM BC/BS
OH0074861OtherMEDICAID ODADAS
OH01-0693OtherCARF CERTIFICATION
OH0074946OtherMEDICAID ODMH
OHH130910OtherMEDICARE GROUP PTAN