Provider Demographics
NPI:1235697871
Name:KISH, DEBORAH (MACC, LPCA)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:KISH
Suffix:
Gender:F
Credentials:MACC, LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14404 RHIANNON LN
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-1257
Mailing Address - Country:US
Mailing Address - Phone:571-528-8213
Mailing Address - Fax:
Practice Address - Street 1:18125 W CATAWBA AVE STE 5
Practice Address - Street 2:
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-5641
Practice Address - Country:US
Practice Address - Phone:571-528-8213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-02
Last Update Date:2019-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA13945101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional