Provider Demographics
NPI:1346595758
Name:STREET, DEIRDRE W (LCSW, LCAS)
Entity Type:Individual
Prefix:
First Name:DEIRDRE
Middle Name:W
Last Name:STREET
Suffix:
Gender:F
Credentials:LCSW, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 HENDERSON ST W
Mailing Address - Street 2:
Mailing Address - City:WRIGHTSVILLE BEACH
Mailing Address - State:NC
Mailing Address - Zip Code:28480-1803
Mailing Address - Country:US
Mailing Address - Phone:910-233-0052
Mailing Address - Fax:
Practice Address - Street 1:15 HENDERSON ST W
Practice Address - Street 2:
Practice Address - City:WRIGHTSVILLE BEACH
Practice Address - State:NC
Practice Address - Zip Code:28480-1803
Practice Address - Country:US
Practice Address - Phone:910-233-0052
Practice Address - Fax:910-338-1300
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-23
Last Update Date:2023-07-12
Deactivation Date:2012-09-20
Deactivation Code:
Reactivation Date:2019-03-11
Provider Licenses
StateLicense IDTaxonomies
NCC0076741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical