Individual
DEBRA FANNING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCPC
Contact information
Practice address
180 S MAIN ST FL 4, CANTON, IL 61520-2608
(309) 706-3190
(309) 588-4115
Mailing address
PO BOX 604, BLOOMINGTON, IL 61702-0604
(309) 706-3190
(309) 588-4115
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
180003689
IL
Other
Enumeration date
05/02/2013
Last updated
05/02/2013
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