Provider Demographics
NPI:1295193894
Name:ANDERSON, DEBRA (LPCA)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 WINSTON WAY
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:KY
Mailing Address - Zip Code:40601-4552
Mailing Address - Country:US
Mailing Address - Phone:502-320-9484
Mailing Address - Fax:
Practice Address - Street 1:408 WINSTON WAY
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40601-4552
Practice Address - Country:US
Practice Address - Phone:502-320-9484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-10
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYLPCCCA00223730101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional