Provider Demographics
NPI:1821866781
Name:DEBROECK, ELIZABETH DIONNE
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:DIONNE
Last Name:DEBROECK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49713 GORMAN POST RD
Mailing Address - Street 2:
Mailing Address - City:GORMAN
Mailing Address - State:CA
Mailing Address - Zip Code:93243-9701
Mailing Address - Country:US
Mailing Address - Phone:661-724-0001
Mailing Address - Fax:
Practice Address - Street 1:49713 GORMAN POST RD
Practice Address - Street 2:
Practice Address - City:GORMAN
Practice Address - State:CA
Practice Address - Zip Code:93243-9701
Practice Address - Country:US
Practice Address - Phone:661-724-0001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-19
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1375780120101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)