Provider Demographics
NPI:1558074211
Name:WALLACE-PRATT, DEBBIE ANN (LCSWA)
Entity Type:Individual
Prefix:MS
First Name:DEBBIE
Middle Name:ANN
Last Name:WALLACE-PRATT
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5401 LEAFORD CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28227-3162
Mailing Address - Country:US
Mailing Address - Phone:704-804-9720
Mailing Address - Fax:
Practice Address - Street 1:2401 SARDIS RD N STE 120
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28227-7722
Practice Address - Country:US
Practice Address - Phone:704-227-0625
Practice Address - Fax:704-227-0691
Is Sole Proprietor?:No
Enumeration Date:2022-12-27
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP018419-A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical