Provider Demographics
NPI:1639544562
Name:ECHTENKAMP, DEBRA (MA/CAS)
Entity Type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:
Last Name:ECHTENKAMP
Suffix:
Gender:F
Credentials:MA/CAS
Other - Prefix:MS
Other - First Name:DEBRA
Other - Middle Name:CATHERINE
Other - Last Name:WOTHERSPOON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA/CAS
Mailing Address - Street 1:19 E MARKET ST LOWR LEVEL
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-3004
Mailing Address - Country:US
Mailing Address - Phone:703-621-7121
Mailing Address - Fax:
Practice Address - Street 1:19 E MARKET ST LOWR LEVEL
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-3004
Practice Address - Country:US
Practice Address - Phone:703-621-7121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-03
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool