Provider Demographics
NPI:1124915814
Name:VIZCARRONDO, DEBORAH MELISSA (LAMFT)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:MELISSA
Last Name:VIZCARRONDO
Suffix:
Gender:F
Credentials:LAMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-2934
Mailing Address - Country:US
Mailing Address - Phone:220-778-7210
Mailing Address - Fax:
Practice Address - Street 1:2717 WINDEMERE DR STE B
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-1690
Practice Address - Country:US
Practice Address - Phone:229-778-7210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-23
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAMFT000877106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist