Provider Demographics
NPI:1558832915
Name:KACHIK, DEBRA K (PHD)
Entity Type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:K
Last Name:KACHIK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1829 DREAM MINT WAY
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-7279
Mailing Address - Country:US
Mailing Address - Phone:410-751-5325
Mailing Address - Fax:
Practice Address - Street 1:125 N COURT ST
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-5192
Practice Address - Country:US
Practice Address - Phone:410-751-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-11
Last Update Date:2018-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04358103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist