Healthcare Provider Details

I. General information

NPI: 1467555318
Provider Name (Legal Business Name): DEBORAH MABIN LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 04/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 CRAWFORD AVE SUITE 12
EVANSTON IL
60201-4900
US

IV. Provider business mailing address

2110 CLEVELAND ST
EVANSTON IL
60202-1914
US

V. Phone/Fax

Practice location:
  • Phone: 847-217-4978
  • Fax: 847-864-6343
Mailing address:
  • Phone: 847-217-4967
  • Fax: 847-864-6343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180003414
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number180003414
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: