Provider Demographics
NPI:1720363922
Name:TALLARICO, DEBORAH (LPC)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:TALLARICO
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 1:1064 MEADOWVIEW DR
Mailing Address - Street 2:SUITE 5
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-4821
Mailing Address - Country:US
Mailing Address - Phone:828-773-7891
Mailing Address - Fax:828-265-1535
Practice Address - Street 1:1064 MEADOWVIEW DR
Practice Address - Street 2:SUITE 5
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-4821
Practice Address - Country:US
Practice Address - Phone:828-773-7891
Practice Address - Fax:828-265-1535
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-19
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8551101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional