Provider Demographics
NPI:1467772384
Name:PICKARD, DEBORAH LEE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:LEE
Last Name:PICKARD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 W VERNON AVE
Mailing Address - Street 2:
Mailing Address - City:KINSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28501-3616
Mailing Address - Country:US
Mailing Address - Phone:828-545-2715
Mailing Address - Fax:910-642-0587
Practice Address - Street 1:1100 W VERNON AVE
Practice Address - Street 2:
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28501-3616
Practice Address - Country:US
Practice Address - Phone:828-545-2715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-02
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0045811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1467772384OtherNPI