Provider Demographics
NPI:1821333832
Name:LAURIE, DEBRA MARIE (MSW, LISAC)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:MARIE
Last Name:LAURIE
Suffix:
Gender:F
Credentials:MSW, LISAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5062 N 19TH AVE
Mailing Address - Street 2:SUITE # 102
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85015-3225
Mailing Address - Country:US
Mailing Address - Phone:623-939-6567
Mailing Address - Fax:623-939-7365
Practice Address - Street 1:5062 N 19TH AVE
Practice Address - Street 2:SUITE # 102
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-3225
Practice Address - Country:US
Practice Address - Phone:623-939-6567
Practice Address - Fax:623-939-7365
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-02
Last Update Date:2012-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC-1673101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)