Provider Demographics
NPI:1275527459
Name:WINFREY, DEBOREA WILLIAMS (PHD)
Entity Type:Individual
Prefix:
First Name:DEBOREA
Middle Name:WILLIAMS
Last Name:WINFREY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 N SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27101
Mailing Address - Country:US
Mailing Address - Phone:336-774-3988
Mailing Address - Fax:336-774-3989
Practice Address - Street 1:122 N SPRUCE ST
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27101
Practice Address - Country:US
Practice Address - Phone:336-774-3988
Practice Address - Fax:336-774-3989
Is Sole Proprietor?:No
Enumeration Date:2005-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1015103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC44407OtherBCBS OF NC
NC00141648OtherRAILROAD MEDICARE
NC6000596Medicaid
NC6000045Medicaid
NC00141648OtherRAILROAD MEDICARE