Provider Demographics
NPI:1659540003
Name:KING, DEBORAH ANN
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ANN
Last Name:KING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 KILDAIRE RD STE 104
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27516-4064
Mailing Address - Country:US
Mailing Address - Phone:984-999-0731
Mailing Address - Fax:984-203-6253
Practice Address - Street 1:301 KILDAIRE RD STE 104
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27516-4064
Practice Address - Country:US
Practice Address - Phone:984-999-0731
Practice Address - Fax:984-203-6253
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-29
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.0500574-CR101YM0800X
NCS12008101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health