Provider Demographics
NPI:1558589283
Name:POWLEY, DEBRA RUTH (MFT)
Entity Type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:RUTH
Last Name:POWLEY
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:940 ADAMS ST
Mailing Address - Street 2:SUITE K
Mailing Address - City:BENICIA
Mailing Address - State:CA
Mailing Address - Zip Code:94510-2950
Mailing Address - Country:US
Mailing Address - Phone:707-745-2186
Mailing Address - Fax:707-745-2186
Practice Address - Street 1:940 ADAMS ST
Practice Address - Street 2:SUITE K
Practice Address - City:BENICIA
Practice Address - State:CA
Practice Address - Zip Code:94510-2950
Practice Address - Country:US
Practice Address - Phone:707-745-2186
Practice Address - Fax:707-745-2186
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC34709106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist