Provider Demographics
NPI:1659577260
Name:MAYBERRY, DEBORAH BOWEN (LPC)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:BOWEN
Last Name:MAYBERRY
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 1:19 BRIXHAM CT
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-7667
Mailing Address - Country:US
Mailing Address - Phone:540-657-2486
Mailing Address - Fax:
Practice Address - Street 1:19 BRIXHAM CT
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-7667
Practice Address - Country:US
Practice Address - Phone:540-657-2486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2199101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor