Healthcare Provider Details

I. General information

NPI: 1760726806
Provider Name (Legal Business Name): DEBRA ANN TOLLIVER LPC, CDCI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. DEBRA ANN ELLIOTT

II. Dates (important events)

Enumeration Date: 11/15/2012
Last Update Date: 05/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4050 LAKE OTIS PKWY STE. 103
ANCHORAGE AK
99508-5223
US

IV. Provider business mailing address

4050 LAKE OTIS PKWY STE. 103
ANCHORAGE AK
99508-5223
US

V. Phone/Fax

Practice location:
  • Phone: 907-317-6306
  • Fax:
Mailing address:
  • Phone: 907-317-6306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberPCOP823
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberPCOP823
License Number StateAK
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPCOP823
License Number StateAK
# 4
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPCOP823
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: