Provider Demographics
NPI:1801552575
Name:FACIANE, DEBORA ANN (MS, MFTA)
Entity type:Individual
Prefix:MS
First Name:DEBORA
Middle Name:ANN
Last Name:FACIANE
Suffix:
Gender:F
Credentials:MS, MFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5185 SOUTHPOINT DR APT 328
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40229-3198
Mailing Address - Country:US
Mailing Address - Phone:323-382-9753
Mailing Address - Fax:
Practice Address - Street 1:5185 SOUTHPOINT DR APT 328
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40229-3198
Practice Address - Country:US
Practice Address - Phone:323-382-9753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-16
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY270636101YM0800X, 106H00000X
KY171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist