Provider Demographics
NPI:1487861019
Name:EVENSTAD, DEBORAH A (LPCC)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:A
Last Name:EVENSTAD
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 CHERRY HL
Mailing Address - Street 2:
Mailing Address - City:SANTA TERESA
Mailing Address - State:NM
Mailing Address - Zip Code:88008-9428
Mailing Address - Country:US
Mailing Address - Phone:505-589-0970
Mailing Address - Fax:505-589-0970
Practice Address - Street 1:206 CHERRY HL
Practice Address - Street 2:
Practice Address - City:SANTA TERESA
Practice Address - State:NM
Practice Address - Zip Code:88008-9428
Practice Address - Country:US
Practice Address - Phone:505-589-0970
Practice Address - Fax:505-589-0970
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3569101YA0400X
NM2025101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional