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General NPI Number Information
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NPI Number | 1619292885
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Entity Type | Individual
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Provider Name | DEBRA K MAIN MS, LPC
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Gender | Female
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Dates
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Enumeration Date | 03/31/2010
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Last Update Date | 11/03/2022
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Provider Practice Location Address
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Address Line | 352 LANTANA RD
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City | CROSSVILLE
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State | TN
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Zip | 38555-4900
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Country | US
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Telephone | 931-707-8200
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Fax |
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Provider Business Mailing Address
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Address Line | 352 LANTANA RD
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City | CROSSVILLE
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State | TN
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Zip | 38555-4900
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Country | US
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Telephone | 931-707-8200
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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 | PC005461
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 05938
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License Number State | TN
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