Provider Demographics
NPI:1972656304
Name:OLLIS, DEBORAH PENDLETON (MA, LPC)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:PENDLETON
Last Name:OLLIS
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1306 BOWMAN AVENUE EXT
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-9571
Mailing Address - Country:US
Mailing Address - Phone:828-437-6019
Mailing Address - Fax:828-437-6019
Practice Address - Street 1:1306 BOWMAN AVENUE EXT
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-9571
Practice Address - Country:US
Practice Address - Phone:828-437-6019
Practice Address - Fax:828-437-6019
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2824101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102075Medicaid