Provider Demographics
NPI:1184687477
Name:DEBERRY, STEPHEN T (PHD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:T
Last Name:DEBERRY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 1/2 WALL ST
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-2732
Mailing Address - Country:US
Mailing Address - Phone:828-251-0985
Mailing Address - Fax:828-251-1419
Practice Address - Street 1:12 1/2 WALL ST
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-2732
Practice Address - Country:US
Practice Address - Phone:828-251-0985
Practice Address - Fax:828-251-1419
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-08
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1773103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6000005Medicaid