Individual
DEBORAH LYNN DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPCC, LMAC
Contact information
Practice address
2424 32ND AVE S, SUITE 202, GRAND FORKS, ND 58201-6545
(701) 746-6336
(701) 772-1030
Mailing address
2424 32ND AVE S, SUITE 202, GRAND FORKS, ND 58201-6545
(701) 746-6336
(701) 772-1030
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
1180
ND
101YP2500X
Professional Counselor
Primary
881-7-1-16-176
ND
171M00000X
Case Manager/Care Coordinator
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
012197
BCBS ND PROVIDER NUMBER
ND
05
—
054519
—
ND
01
—
9G411DA
BCBS MN PROVIDER NUMBER
MN
Enumeration date
07/07/2006
Last updated
02/28/2024
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