Provider Demographics
NPI:1619192382
Name:DEBO, DARREN LEE (LCSW)
Entity Type:Individual
Prefix:MR
First Name:DARREN
Middle Name:LEE
Last Name:DEBO
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1367 REGULATOR ST
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27603-3496
Mailing Address - Country:US
Mailing Address - Phone:919-720-4571
Mailing Address - Fax:919-720-4571
Practice Address - Street 1:1367 REGULATOR ST
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27603-3496
Practice Address - Country:US
Practice Address - Phone:919-720-4571
Practice Address - Fax:919-720-4571
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0055941041C0700X
FL59541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6106642Medicaid