Provider Demographics
NPI:1063937704
Name:HEBERT, DEAN ALAN (LMBT)
Entity type:Individual
Prefix:
First Name:DEAN
Middle Name:ALAN
Last Name:HEBERT
Suffix:
Gender:M
Credentials:LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2416 GAZEBO DR APT G
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-9672
Mailing Address - Country:US
Mailing Address - Phone:1919-400-1609
Mailing Address - Fax:
Practice Address - Street 1:729 HUNTER ST
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-1325
Practice Address - Country:US
Practice Address - Phone:191-940-0160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-03
Last Update Date:2017-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10820225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty