Provider Demographics
NPI:1659496800
Name:HAVILL, DEBRA LYNN (MSW, ACSW, LCSW)
Entity type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:LYNN
Last Name:HAVILL
Suffix:
Gender:F
Credentials:MSW, ACSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9135 N MERIDIAN ST
Mailing Address - Street 2:STE A9
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-1815
Mailing Address - Country:US
Mailing Address - Phone:317-502-5781
Mailing Address - Fax:317-581-1781
Practice Address - Street 1:9135 N MERIDIAN ST
Practice Address - Street 2:STE A9
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-1815
Practice Address - Country:US
Practice Address - Phone:317-502-5781
Practice Address - Fax:317-581-1781
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34001968A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
INM300060162Medicare PIN