Provider Demographics
NPI:1669450276
Name:COUSINS, DEBORAH GOODRICH (CPHT)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:GOODRICH
Last Name:COUSINS
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9012 CIRCLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23803-7746
Mailing Address - Country:US
Mailing Address - Phone:804-524-7346
Mailing Address - Fax:804-524-4718
Practice Address - Street 1:26317 WEST WASHINGTON STREET
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23803-0030
Practice Address - Country:US
Practice Address - Phone:804-524-7346
Practice Address - Fax:804-524-4718
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0230004347183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician