Provider Demographics
NPI:1467659136
Name:LEES-SHEPARD, DEBORAH B (PHD, LPC, FAPA)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:B
Last Name:LEES-SHEPARD
Suffix:
Gender:F
Credentials:PHD, LPC, FAPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 PINNACLE CT
Mailing Address - Street 2:
Mailing Address - City:KITTY HAWK
Mailing Address - State:NC
Mailing Address - Zip Code:27949-5911
Mailing Address - Country:US
Mailing Address - Phone:252-261-5454
Mailing Address - Fax:
Practice Address - Street 1:108 PINNACLE CT
Practice Address - Street 2:
Practice Address - City:KITTY HAWK
Practice Address - State:NC
Practice Address - Zip Code:27949-5911
Practice Address - Country:US
Practice Address - Phone:252-261-5454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NC696101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC51568OtherBCBS ID#