Provider Demographics
NPI:1316052657
Name:DEBORD, MICHELLE GUY (LCSW)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:GUY
Last Name:DEBORD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:434 MITCHELL VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:VA
Mailing Address - Zip Code:24354-6338
Mailing Address - Country:US
Mailing Address - Phone:276-783-7600
Mailing Address - Fax:276-783-1802
Practice Address - Street 1:434 MITCHELL VALLEY DR
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:VA
Practice Address - Zip Code:24354-6338
Practice Address - Country:US
Practice Address - Phone:276-783-7600
Practice Address - Fax:276-783-1802
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2015-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040063841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1316052657OtherNPI
VA004945298Medicaid
VA0904006384OtherLICENSE
VA13583210OtherCAQH