Provider Demographics
NPI:1326167388
Name:COLBERT, DEBORAH JOANN (LAC)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:JOANN
Last Name:COLBERT
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:MS
Other - First Name:DEBORAH
Other - Middle Name:JOANN
Other - Last Name:COLBERT-VIDAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:3912 DENFELD AVE
Mailing Address - Street 2:
Mailing Address - City:KENSINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20895-1509
Mailing Address - Country:US
Mailing Address - Phone:301-946-6089
Mailing Address - Fax:
Practice Address - Street 1:3912 DENFELD AVE
Practice Address - Street 2:
Practice Address - City:KENSINGTON
Practice Address - State:MD
Practice Address - Zip Code:20895-1509
Practice Address - Country:US
Practice Address - Phone:301-946-6089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU01302171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist