Provider Demographics
NPI:1841726379
Name:HUDDLESTON, DEBRA L (LCPC)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:L
Last Name:HUDDLESTON
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 REMINGTON RD STE B
Mailing Address - Street 2:
Mailing Address - City:MATTOON
Mailing Address - State:IL
Mailing Address - Zip Code:61938-4210
Mailing Address - Country:US
Mailing Address - Phone:217-923-3311
Mailing Address - Fax:217-234-3094
Practice Address - Street 1:911 REMINGTON RD STE B
Practice Address - Street 2:
Practice Address - City:MATTOON
Practice Address - State:IL
Practice Address - Zip Code:61938-4210
Practice Address - Country:US
Practice Address - Phone:217-923-3311
Practice Address - Fax:217-234-3094
Is Sole Proprietor?:No
Enumeration Date:2017-05-03
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)