Provider Demographics
NPI:1043537780
Name:WARD, DEBORAH (LPC)
Entity type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:
Last Name:WARD
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:PO BOX 2721
Mailing Address - Street 2:
Mailing Address - City:VIDALIA
Mailing Address - State:GA
Mailing Address - Zip Code:30475-2721
Mailing Address - Country:US
Mailing Address - Phone:478-494-2314
Mailing Address - Fax:912-538-8186
Practice Address - Street 1:310 DURDEN ST
Practice Address - Street 2:
Practice Address - City:VIDALIA
Practice Address - State:GA
Practice Address - Zip Code:30474-4606
Practice Address - Country:US
Practice Address - Phone:478-494-2314
Practice Address - Fax:912-538-8186
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-20
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003419101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional