Provider Demographics
NPI:1942614706
Name:DEBUTTS FARREN, DESIREE (CADC, ICADC)
Entity Type:Individual
Prefix:MRS
First Name:DESIREE
Middle Name:
Last Name:DEBUTTS FARREN
Suffix:
Gender:F
Credentials:CADC, ICADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425-B CARLISLE DRIVE
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170
Mailing Address - Country:US
Mailing Address - Phone:703-464-5122
Mailing Address - Fax:
Practice Address - Street 1:425-B CARLISLE DRIVE
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170
Practice Address - Country:US
Practice Address - Phone:703-464-5122
Practice Address - Fax:703-464-5822
Is Sole Proprietor?:No
Enumeration Date:2014-06-19
Last Update Date:2014-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VASACAUA 1203101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)