Provider Demographics
NPI:1255599411
Name:WIMBERLY, DEBORAH K (MED)
Entity type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:K
Last Name:WIMBERLY
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 CALLE OJO FELIZ
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-5717
Mailing Address - Country:US
Mailing Address - Phone:505-501-1845
Mailing Address - Fax:
Practice Address - Street 1:2074 GALISTEO ST
Practice Address - Street 2:SUITE B-4
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-2138
Practice Address - Country:US
Practice Address - Phone:505-501-1845
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-23
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM005779101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health