Provider Demographics
NPI:1144587478
Name:DALY, DEIDRE LYNN (LPC)
Entity Type:Individual
Prefix:
First Name:DEIDRE
Middle Name:LYNN
Last Name:DALY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5415 SE MILWAUKIE AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-4940
Mailing Address - Country:US
Mailing Address - Phone:503-233-5405
Mailing Address - Fax:
Practice Address - Street 1:428 BILTMORE AVE
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-4502
Practice Address - Country:US
Practice Address - Phone:828-213-4502
Practice Address - Fax:828-213-4540
Is Sole Proprietor?:No
Enumeration Date:2012-04-11
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14284101Y00000X, 101YP2500X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor