Healthcare Provider Details

I. General information

NPI: 1992578207
Provider Name (Legal Business Name): DEBORAH KATHLEEN ELKINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2023
Last Update Date: 05/28/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3727 SUNSET LN
ANTIOCH CA
94509-6134
US

IV. Provider business mailing address

3727 SUNSET LN
ANTIOCH CA
94509-6134
US

V. Phone/Fax

Practice location:
  • Phone: 925-753-2156
  • Fax:
Mailing address:
  • Phone: 925-753-2156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: