Provider Demographics
NPI:1972720001
Name:MARTIN, DEBORA (MA, LCADC)
Entity Type:Individual
Prefix:MRS
First Name:DEBORA
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MA, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 W SANTA ANA BLVD STE 108
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92701-4582
Mailing Address - Country:US
Mailing Address - Phone:916-501-0999
Mailing Address - Fax:
Practice Address - Street 1:600 W SANTA ANA BLVD STE 108
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-4582
Practice Address - Country:US
Practice Address - Phone:916-501-0999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARA018290415101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARA018290415OtherCADC