Provider Demographics
NPI:1962827238
Name:HASKINS, DEBORAH AMELIA (MS, LADC, CCS)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:AMELIA
Last Name:HASKINS
Suffix:
Gender:F
Credentials:MS, LADC, CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05676-1550
Mailing Address - Country:US
Mailing Address - Phone:802-244-7700
Mailing Address - Fax:802-456-1479
Practice Address - Street 1:65 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:VT
Practice Address - Zip Code:05676-1550
Practice Address - Country:US
Practice Address - Phone:802-244-7700
Practice Address - Fax:802-456-1479
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-24
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VTVT 000004101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)