Provider Demographics
NPI:1780633586
Name:ALLDREDGE, DEBRA JAN WILKINSON (MA, ATR-BC, LPC-AT,)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:JAN WILKINSON
Last Name:ALLDREDGE
Suffix:
Gender:F
Credentials:MA, ATR-BC, LPC-AT,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 BROOKS ST
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-3228
Mailing Address - Country:US
Mailing Address - Phone:281-980-0083
Mailing Address - Fax:281-565-6150
Practice Address - Street 1:214 BROOKS ST
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-3228
Practice Address - Country:US
Practice Address - Phone:281-980-0083
Practice Address - Fax:281-565-6150
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11308101YP2500X
TX003595106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXLP0025866Medicaid