Provider Demographics
NPI:1558585620
Name:COLTON, DEBORAH DIANE (LICSW)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:DIANE
Last Name:COLTON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1304 COUNTY 5
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:ND
Mailing Address - Zip Code:58541-9617
Mailing Address - Country:US
Mailing Address - Phone:701-451-4900
Mailing Address - Fax:
Practice Address - Street 1:411 N 4TH ST STE 10
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-4078
Practice Address - Country:US
Practice Address - Phone:701-255-1165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND26251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND27165OtherBCBSND
ND19173Medicaid