Individual
MISS DEBORAH LYNN DETTMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW, LICSW, SUDP
Contact information
Practice address
1209 W SHERWIN AVE APT 809, CHICAGO, IL 60626-2257
(301) 202-4424
Mailing address
1209 W SHERWIN AVE APT 809, CHICAGO, IL 60626-2257
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
CP00001620
WA
1041C0700X
Clinical Social Worker
Primary
149.008106
IL
1041C0700X
Clinical Social Worker
LW00005466
WA
Other
Enumeration date
09/01/2020
Last updated
09/01/2020
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