Provider Demographics
NPI:1982058012
Name:HEATON, DEBRA A (LISAC)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:A
Last Name:HEATON
Suffix:
Gender:F
Credentials:LISAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4825 N SABINO CANYON RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85750-6427
Mailing Address - Country:US
Mailing Address - Phone:520-882-0090
Mailing Address - Fax:520-884-0383
Practice Address - Street 1:324 S OCOTILLO AVE
Practice Address - Street 2:
Practice Address - City:BENSON
Practice Address - State:AZ
Practice Address - Zip Code:85602-6401
Practice Address - Country:US
Practice Address - Phone:520-720-6122
Practice Address - Fax:520-720-6236
Is Sole Proprietor?:No
Enumeration Date:2016-04-14
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC-1045101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZLISAC-1045OtherAZ BOARD OF BEHAVIORAL HEALTH EXAMINERS