Provider Demographics
NPI:1326199415
Name:HALLIDAY, DEBRA (MA, MFT, SEP)
Entity Type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:
Last Name:HALLIDAY
Suffix:
Gender:F
Credentials:MA, MFT, SEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 233
Mailing Address - Street 2:
Mailing Address - City:ALAMO
Mailing Address - State:CA
Mailing Address - Zip Code:94507-0233
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3468 MT DIABLO BLVD STE B201
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CA
Practice Address - Zip Code:94549-3959
Practice Address - Country:US
Practice Address - Phone:925-286-4415
Practice Address - Fax:925-284-1599
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2009-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC46000106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist