Provider Demographics
NPI:1598116113
Name:DRAKE, DEBRA N (LPC)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:N
Last Name:DRAKE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 RICHFORD RD
Mailing Address - Street 2:
Mailing Address - City:KENDALL PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08824-1107
Mailing Address - Country:US
Mailing Address - Phone:347-615-1777
Mailing Address - Fax:
Practice Address - Street 1:17 RICHFORD RD
Practice Address - Street 2:
Practice Address - City:KENDALL PARK
Practice Address - State:NJ
Practice Address - Zip Code:08824-1107
Practice Address - Country:US
Practice Address - Phone:347-615-1777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-24
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00484800101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional