Provider Demographics
NPI:1174846653
Name:BOUCHA, DEBORAH WACHTER (LMSW)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:WACHTER
Last Name:BOUCHA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 CHIPPEWA ST
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48503-1552
Mailing Address - Country:US
Mailing Address - Phone:810-232-9950
Mailing Address - Fax:810-232-7599
Practice Address - Street 1:120 W EXCHANGE ST
Practice Address - Street 2:SUITE 300
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867-2834
Practice Address - Country:US
Practice Address - Phone:989-723-8239
Practice Address - Fax:989-723-8230
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-11
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010890361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical