Healthcare Provider Details

I. General information

NPI: 1366924961
Provider Name (Legal Business Name): DEBRA LYNN MAINS CDPR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2018
Last Update Date: 12/09/2020
Certification Date: 12/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 N 7TH AVE
PASCO WA
99301-5411
US

IV. Provider business mailing address

224 N 7TH AVE
PASCO WA
99301-5411
US

V. Phone/Fax

Practice location:
  • Phone: 509-545-4462
  • Fax: 509-545-8076
Mailing address:
  • Phone: 509-545-4462
  • Fax: 509-545-8076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number60810833
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN00145819
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: