Provider Demographics
NPI:1184341091
Name:EASTHAM, DEBORAH A (MA MENTAL HEALTH COU)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:A
Last Name:EASTHAM
Suffix:
Gender:F
Credentials:MA MENTAL HEALTH COU
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:A
Other - Last Name:EASTHAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:5179 LYNN CREEK RD
Mailing Address - Street 2:
Mailing Address - City:LAVALETTE
Mailing Address - State:WV
Mailing Address - Zip Code:25535-9712
Mailing Address - Country:US
Mailing Address - Phone:304-617-2211
Mailing Address - Fax:
Practice Address - Street 1:5179 LYNN CREEK RD
Practice Address - Street 2:
Practice Address - City:LAVALETTE
Practice Address - State:WV
Practice Address - Zip Code:25535-9712
Practice Address - Country:US
Practice Address - Phone:304-617-2211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-21
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health