Provider Demographics
NPI:1720639115
Name:SMITH, DEBORAH DIMMICK (PHD)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:DIMMICK
Last Name:SMITH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:K
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8751 E HAMPDEN AVE STE B9
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-4929
Mailing Address - Country:US
Mailing Address - Phone:613-650-7614
Mailing Address - Fax:
Practice Address - Street 1:8751 E HAMPDEN AVE STE B9
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80231-4929
Practice Address - Country:US
Practice Address - Phone:613-650-7614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-26
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4813101YA0400X
CO1078103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)