Provider Demographics
NPI:1124189428
Name:EVERSON, DEBRA MISSY G (LCSW, DCSW)
Entity type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:MISSY G
Last Name:EVERSON
Suffix:
Gender:F
Credentials:LCSW, DCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7330 FERN AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-4971
Mailing Address - Country:US
Mailing Address - Phone:318-798-7664
Mailing Address - Fax:318-861-1710
Practice Address - Street 1:7330 FERN AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-4971
Practice Address - Country:US
Practice Address - Phone:318-798-7664
Practice Address - Fax:318-861-1710
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA16531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical