Provider Demographics
NPI:1588797542
Name:WINES, DEBORAH CAROL (LPC LISCN PROF COUNS)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:CAROL
Last Name:WINES
Suffix:
Gender:F
Credentials:LPC LISCN PROF COUNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 WILLIAMS STREET
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75087-2739
Mailing Address - Country:US
Mailing Address - Phone:817-461-5460
Mailing Address - Fax:817-886-8674
Practice Address - Street 1:1414 WEST RANDOL MILL ROAD
Practice Address - Street 2:SUITE 200 EXECUTIVE SUITES
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-3158
Practice Address - Country:US
Practice Address - Phone:817-461-5460
Practice Address - Fax:817-886-8674
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXLPC2791101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional