Provider Demographics
NPI:1003860362
Name:DEACON, DEBORAH B (LCSW)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:B
Last Name:DEACON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 GOSHEN AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72116-8933
Mailing Address - Country:US
Mailing Address - Phone:501-944-0030
Mailing Address - Fax:
Practice Address - Street 1:1920 MAIN ST
Practice Address - Street 2:SUITE 231
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72114-2872
Practice Address - Country:US
Practice Address - Phone:501-944-0030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-20
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1577-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5X650Medicare ID - Type Unspecified