Provider Demographics
NPI:1083075527
Name:DE LA GARZA, DEBRA (LCSW, CADC)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:DE LA GARZA
Suffix:
Gender:F
Credentials:LCSW, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:238 QUAIL RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CAMPBELLSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42718-8714
Mailing Address - Country:US
Mailing Address - Phone:270-505-2665
Mailing Address - Fax:
Practice Address - Street 1:238 QUAIL RIDGE RD
Practice Address - Street 2:
Practice Address - City:CAMPBELLSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42718-8714
Practice Address - Country:US
Practice Address - Phone:270-505-2665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-11
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1095101YA0400X
KY35931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)