Provider Demographics
NPI:1689707390
Name:GRACIA, DEBORAH STANTON (LCSW, LDC)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:STANTON
Last Name:GRACIA
Suffix:
Gender:F
Credentials:LCSW, LDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 JORDAN DR
Mailing Address - Street 2:JORDAN PROFESSIONAL BUILDING
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-6732
Mailing Address - Country:US
Mailing Address - Phone:423-499-8894
Mailing Address - Fax:423-886-7017
Practice Address - Street 1:101 JORDAN DR
Practice Address - Street 2:JORDAN PROFESSIONAL BUILDING
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-6732
Practice Address - Country:US
Practice Address - Phone:423-499-8894
Practice Address - Fax:423-886-7017
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLDC200101YA0400X
TNTN9841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY4295328OtherPIN NUMBER
FL145218Medicaid
TN0145218OtherPIN NUMBER
TN0145218OtherPIN NUMBER