Provider Demographics
NPI:1255676136
Name:FREEMAN, DEBORAH PATRICIA (CADC-II, LAADC, CSC)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:PATRICIA
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:CADC-II, LAADC, CSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 S SUNSHINE AVE
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-4427
Mailing Address - Country:US
Mailing Address - Phone:619-569-0047
Mailing Address - Fax:
Practice Address - Street 1:892 27TH ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92154-1444
Practice Address - Country:US
Practice Address - Phone:619-575-4687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-04
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA8528505 / LNR350411101YA0400X
320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness