Provider Demographics
NPI:1235124090
Name:RICH, DEBORAH KAYE (LCSW LPC MAC)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:KAYE
Last Name:RICH
Suffix:
Gender:F
Credentials:LCSW LPC MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 E NEW HAMPSHIRE AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTHERN PINES
Mailing Address - State:NC
Mailing Address - Zip Code:28387-5529
Mailing Address - Country:US
Mailing Address - Phone:910-692-9100
Mailing Address - Fax:910-692-9109
Practice Address - Street 1:185 E NEW HAMPSHIRE AVE
Practice Address - Street 2:
Practice Address - City:SOUTHERN PINES
Practice Address - State:NC
Practice Address - Zip Code:28387-5529
Practice Address - Country:US
Practice Address - Phone:910-692-9100
Practice Address - Fax:910-692-9109
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-16
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0019871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6002147Medicaid
NC2871284Medicare ID - Type Unspecified