Provider Demographics
NPI:1467555318
Name:MABIN, DEBORAH (LCPC)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:MABIN
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2110 CLEVELAND ST
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-1914
Mailing Address - Country:US
Mailing Address - Phone:847-217-4967
Mailing Address - Fax:847-864-6343
Practice Address - Street 1:2550 CRAWFORD AVE
Practice Address - Street 2:SUITE 12
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-4900
Practice Address - Country:US
Practice Address - Phone:847-217-4978
Practice Address - Fax:847-864-6343
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1800034141041C0700X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL363300648OtherTAX ID