MEDICARE: DEBE ENTERPRISES INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TM1800X	Intellectual & Developmental Disabilities Psychologist

General Provider Information

NPI Number	:	1255176426
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEBE ENTERPRISES INC

Provider Business Mailing Address
First Line	:	1219 EDENVILLE DRIVE
Second Line	:
City	:	DISTRICT HEIGHTS
State	:	MD
Zip	:	20747
Country	:	US
Telephone Number	:	301-336-1493
Fax Number	:

Provider Business Practice Location Address
First Line	:	1219 EDENVILLE DRIVE
Second Line	:
City	:	DISTRICT HEIGHTS
State	:	MD
Zip	:	20747
Country	:	US
Telephone Number	:	301-336-1493
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	TAWANA DICKERSON BYNUM
Credential	:
Telephone Number	:	301-922-7208

Provider Enumeration Date	:	06/28/2024
Last Update Date	:	06/28/2024

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