Provider Demographics
NPI:1811303118
Name:DEBORD, MARY ANGELYN (LPC)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ANGELYN
Last Name:DEBORD
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 GRAZING ACRES DR
Mailing Address - Street 2:
Mailing Address - City:NICKELSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24271-3329
Mailing Address - Country:US
Mailing Address - Phone:276-479-2062
Mailing Address - Fax:
Practice Address - Street 1:409 GRAZING ACRES DR
Practice Address - Street 2:
Practice Address - City:NICKELSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24271-3329
Practice Address - Country:US
Practice Address - Phone:276-479-2062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-08
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701005838101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health