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General NPI Number Information
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NPI Number | 1154549731
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Entity Type | Individual
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Provider Name | DEBRA G. CHARVERON LCPC
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Gender | Female
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Dates
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Enumeration Date | 04/21/2007
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Last Update Date | 07/09/2008
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Provider Practice Location Address
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Address Line | 1770 E LAKE SHORE DR
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City | DECATUR
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State | IL
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Zip | 62521-3832
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Country | US
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Telephone | 217-429-9700
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Fax |
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Provider Business Mailing Address
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Address Line | 4340 LAWSON DR
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City | DECATUR
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State | IL
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Zip | 62526-1127
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Country | US
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Telephone | 217-875-7595
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 180003894
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License Number State | IL
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