Provider Demographics
NPI:1558555797
Name:DUDLEY, DEBRA ANN (MA)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:ANN
Last Name:DUDLEY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 757
Mailing Address - Street 2:
Mailing Address - City:NEWCASTLE
Mailing Address - State:CA
Mailing Address - Zip Code:95658-0757
Mailing Address - Country:US
Mailing Address - Phone:530-888-1246
Mailing Address - Fax:
Practice Address - Street 1:333 SUNRISE AVE
Practice Address - Street 2:STE. 360
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3479
Practice Address - Country:US
Practice Address - Phone:530-888-1246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-30
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 24404106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist