Individual
DEBRA DIANE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
2900 W PROSPECT RD, FORT LAUDERDALE, FL 33309-2519
(954) 731-5100
(954) 497-3857
Mailing address
4740 N STATE ROAD 7 STE 201, LAUDERDALE LAKES, FL 33319-5839
(954) 777-1617
(954) 497-3857
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
SW10293
FL
1041C0700X
Clinical Social Worker
Primary
SW10293
FL
Other
Enumeration date
07/11/2012
Last updated
11/05/2020
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