Provider Demographics
NPI:1447976949
Name:DEBITY, MARINA FILIMONOVA (EDS)
Entity type:Individual
Prefix:
First Name:MARINA
Middle Name:FILIMONOVA
Last Name:DEBITY
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 PONDEROSA DR
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37354-7430
Mailing Address - Country:US
Mailing Address - Phone:423-519-0108
Mailing Address - Fax:
Practice Address - Street 1:129 PONDEROSA DR
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37354-7430
Practice Address - Country:US
Practice Address - Phone:423-519-0108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-17
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN000538923103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool