Provider Demographics
NPI:1376026559
Name:FRUMP, DEBRA JOY (SWA, CTP)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:JOY
Last Name:FRUMP
Suffix:
Gender:F
Credentials:SWA, CTP
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:JOY
Other - Last Name:MAHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SWA, CTP
Mailing Address - Street 1:232 N SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:45177-1649
Mailing Address - Country:US
Mailing Address - Phone:937-414-2016
Mailing Address - Fax:937-366-6814
Practice Address - Street 1:232 N SOUTH ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:OH
Practice Address - Zip Code:45177-1649
Practice Address - Country:US
Practice Address - Phone:937-414-2016
Practice Address - Fax:937-366-6814
Is Sole Proprietor?:No
Enumeration Date:2018-09-13
Last Update Date:2018-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHW1400027104100000X
OHCDCA.168408101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0313627Medicaid