Healthcare Provider Details

I. General information

NPI: 1104846716
Provider Name (Legal Business Name): DEBORAH LYNN DOUBLIN LCSW, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 09/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 WASHINGTON ST SUITE B-2
MONROE LA
71201-6955
US

IV. Provider business mailing address

800 WASHINGTON ST SUITE B-2
MONROE LA
71201-6955
US

V. Phone/Fax

Practice location:
  • Phone: 318-325-8782
  • Fax: 318-325-8749
Mailing address:
  • Phone: 318-325-8782
  • Fax: 318-325-8749

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5183
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number787
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: