Healthcare Provider Details

I. General information

NPI: 1083646988
Provider Name (Legal Business Name): DEBORAH LYNN DAVIS LPCC, LMAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 02/28/2024
Certification Date: 02/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2424 32ND AVE S SUITE 202
GRAND FORKS ND
58201-6545
US

IV. Provider business mailing address

2424 32ND AVE S SUITE 202
GRAND FORKS ND
58201-6545
US

V. Phone/Fax

Practice location:
  • Phone: 701-746-6336
  • Fax: 701-772-1030
Mailing address:
  • Phone: 701-746-6336
  • Fax: 701-772-1030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1180
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number881-7-1-16-176
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: