Provider Demographics
NPI:1356983738
Name:BURROW FORTIN, DEBORAH LILY (LCMHC)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:LILY
Last Name:BURROW FORTIN
Suffix:
Gender:
Credentials:LCMHC
Other - Prefix:
Other - First Name:LILY
Other - Middle Name:
Other - Last Name:FORTIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:26 BEAUMONT DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28739-7050
Mailing Address - Country:US
Mailing Address - Phone:980-428-9429
Mailing Address - Fax:
Practice Address - Street 1:1915 GEORGE ST
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28792-2948
Practice Address - Country:US
Practice Address - Phone:980-428-9429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-17
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA15248101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional