Provider Demographics
NPI:1629107743
Name:WHITE, DEBRA MAE
Entity Type:Individual
Prefix:MISS
First Name:DEBRA
Middle Name:MAE
Last Name:WHITE
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:DEBBIE
Other - Middle Name:MAE
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1435 W 24TH PL
Mailing Address - Street 2:PO BOX 2405
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-1808
Mailing Address - Country:US
Mailing Address - Phone:541-686-9969
Mailing Address - Fax:
Practice Address - Street 1:1790 W 11TH AVE STE 290
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402-3759
Practice Address - Country:US
Practice Address - Phone:541-686-1262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health