Provider Demographics
NPI:1336558113
Name:WALSH, DEBORAH GRAY (LCMHC)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:GRAY
Last Name:WALSH
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5540 CENTERVIEW DR STE 204
Mailing Address - Street 2:#912386
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27606-8012
Mailing Address - Country:US
Mailing Address - Phone:980-705-1285
Mailing Address - Fax:
Practice Address - Street 1:5540 CENTERVIEW DR STE 204
Practice Address - Street 2:#912386
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27606-8012
Practice Address - Country:US
Practice Address - Phone:980-705-1285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-06
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA10981101YM0800X
101YM0800X
NC10981101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health