1336555937 NPI number — DEBORAH LYNN DEVINCENT LCPC

Table of content: DEBORAH LYNN DEVINCENT LCPC (NPI 1336555937)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336555937 NPI number — DEBORAH LYNN DEVINCENT LCPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEVINCENT
Provider First Name:
DEBORAH
Provider Middle Name:
LYNN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336555937
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/02/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5614 COMPTON LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELDERSBURG
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21784-8868
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-952-9966
Provider Business Mailing Address Fax Number:
410-552-9404

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1425 LIBERTY RD
Provider Second Line Business Practice Location Address:
SUITE 206
Provider Business Practice Location Address City Name:
ELDERSBURG
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21784-6420
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-952-9966
Provider Business Practice Location Address Fax Number:
410-552-9404
Provider Enumeration Date:
07/03/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  LC6876 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YA0400X , with the licence number: LC6876 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101Y00000X , with the licence number: LC6876 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YM0800X , with the licence number: LC6876 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: LC6876 . This is a "MARYLAND BOARD OF PROFESSIONAL COUNSELORS AND THERAPISTS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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