Provider Demographics
NPI:1740550573
Name:FUENTES, DEBRA LEE (LPCC-SUPV, LICDC-CS)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:LEE
Last Name:FUENTES
Suffix:
Gender:F
Credentials:LPCC-SUPV, LICDC-CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 PUBLIC SQ STE 105
Mailing Address - Street 2:
Mailing Address - City:WILLOUGHBY
Mailing Address - State:OH
Mailing Address - Zip Code:44094-7864
Mailing Address - Country:US
Mailing Address - Phone:440-488-4081
Mailing Address - Fax:
Practice Address - Street 1:36 PUBLIC SQ
Practice Address - Street 2:SUITE 202
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-7854
Practice Address - Country:US
Practice Address - Phone:440-488-4081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-11
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH031086101YA0400X
OHE8454-SUPV101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)