Provider Demographics
NPI:1326484411
Name:TAIT, DEBRA M (LPC)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:M
Last Name:TAIT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 THRIFT RD
Mailing Address - Street 2:
Mailing Address - City:WOODBINE
Mailing Address - State:GA
Mailing Address - Zip Code:31569-2436
Mailing Address - Country:US
Mailing Address - Phone:352-339-2013
Mailing Address - Fax:
Practice Address - Street 1:801 THRIFT RD
Practice Address - Street 2:
Practice Address - City:WOODBINE
Practice Address - State:GA
Practice Address - Zip Code:31569-2436
Practice Address - Country:US
Practice Address - Phone:352-339-2013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-15
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC008512101YP2500X
101YP2500X
GA008512101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional