Provider Demographics
NPI:1255817151
Name:ROBERTS, DEBRA (SAC, LPC-IT)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:SAC, LPC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:731 N 1ST ST STE 5000
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54403-4727
Mailing Address - Country:US
Mailing Address - Phone:715-297-0972
Mailing Address - Fax:
Practice Address - Street 1:731 N 1ST ST STE 5000
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54403-4727
Practice Address - Country:US
Practice Address - Phone:715-675-3458
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-13
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16463-131101YA0400X
WI18434-130101YA0400X
WI4873-226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)