Healthcare Provider Details

I. General information

NPI: 1982173936
Provider Name (Legal Business Name): DEBORAH HONEYESTEWA CADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2018
Last Update Date: 11/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 RIO VISTA DRIVE
FALLON NV
89406
US

IV. Provider business mailing address

FALLON TRIBAL HEALTH CENTER PO BOX 1980
FALLON NV
89407
US

V. Phone/Fax

Practice location:
  • Phone: 775-423-3634
  • Fax:
Mailing address:
  • Phone: 775-423-3634
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number2015-135
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: