Provider Demographics
NPI:1750004610
Name:UPTON, DEBORAH JEAN (LCSW)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:JEAN
Last Name:UPTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2263 CHAPEL HILL RD
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:MS
Mailing Address - Zip Code:39175-9025
Mailing Address - Country:US
Mailing Address - Phone:601-397-0499
Mailing Address - Fax:
Practice Address - Street 1:2263 CHAPEL HILL RD
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:MS
Practice Address - Zip Code:39175-9025
Practice Address - Country:US
Practice Address - Phone:601-397-0499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011150751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical