Provider Demographics
NPI:1790147890
Name:VAN WIEREN, DEBORAH LORENE (LPC, LCAS)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:LORENE
Last Name:VAN WIEREN
Suffix:
Gender:F
Credentials:LPC, LCAS
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:
Other - Last Name:WHITLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2272
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28793-2272
Mailing Address - Country:US
Mailing Address - Phone:828-692-7300
Mailing Address - Fax:828-692-7710
Practice Address - Street 1:110 WILLIAMS ST
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28792-4543
Practice Address - Country:US
Practice Address - Phone:828-692-7300
Practice Address - Fax:828-692-7710
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-28
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11549101YP2500X
NC22205101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCN/AMedicaid