Provider Demographics
NPI:1245471325
Name:KING, DEBRA ANN (PHD, LPC, LPCS, NCC,)
Entity type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:ANN
Last Name:KING
Suffix:
Gender:F
Credentials:PHD, LPC, LPCS, NCC,
Other - Prefix:DR
Other - First Name:DEBRA
Other - Middle Name:ANN
Other - Last Name:KING-JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD, LPC, LPCS, NCC
Mailing Address - Street 1:3519 PELHAM ROAD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4185
Mailing Address - Country:US
Mailing Address - Phone:864-888-7310
Mailing Address - Fax:888-710-4950
Practice Address - Street 1:3519 PELHAM ROAD
Practice Address - Street 2:SUITE 104
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-4185
Practice Address - Country:US
Practice Address - Phone:864-888-7310
Practice Address - Fax:888-710-4950
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-18
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLPC 2838101Y00000X
SCLPC/S 3689101Y00000X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPC 1162Medicaid