Provider Demographics
NPI:1225235070
Name:ROTTER, DEBORAH LEAH (LCSW, CHT, BCD)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:LEAH
Last Name:ROTTER
Suffix:
Gender:F
Credentials:LCSW, CHT, BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5203 LYNGATE CT
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-1632
Mailing Address - Country:US
Mailing Address - Phone:703-239-0697
Mailing Address - Fax:703-250-0594
Practice Address - Street 1:5203 LYNGATE CT
Practice Address - Street 2:
Practice Address - City:BURKE
Practice Address - State:VA
Practice Address - Zip Code:22015-1632
Practice Address - Country:US
Practice Address - Phone:703-239-0697
Practice Address - Fax:703-250-0594
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040030321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0904003032OtherLICENSURE