Provider Demographics
NPI:1043376957
Name:DEBOER, PATRICIA ANNE (MSW LCSW)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:ANNE
Last Name:DEBOER
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3717 NATIONAL DR
Mailing Address - Street 2:SUITE 215
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612
Mailing Address - Country:US
Mailing Address - Phone:919-782-5444
Mailing Address - Fax:919-782-7203
Practice Address - Street 1:3717 NATIONAL DR
Practice Address - Street 2:SUITE 215
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612
Practice Address - Country:US
Practice Address - Phone:919-782-5444
Practice Address - Fax:919-782-7203
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCSW C0001041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical