Provider Demographics
NPI:1366640880
Name:DEBONE, ANITA DEANDA
Entity Type:Individual
Prefix:MRS
First Name:ANITA
Middle Name:DEANDA
Last Name:DEBONE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 GRAPEVINE RD
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-2427
Mailing Address - Country:US
Mailing Address - Phone:805-925-1773
Mailing Address - Fax:
Practice Address - Street 1:908 GRAPEVINE RD
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-2427
Practice Address - Country:US
Practice Address - Phone:805-925-1773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)