Provider Demographics
NPI:1316297112
Name:DEMERSON, DEBORAH (LCDC)
Entity type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:
Last Name:DEMERSON
Suffix:
Gender:F
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 HORIZON HILL BLVD APT 2107
Mailing Address - Street 2:2107
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-2227
Mailing Address - Country:US
Mailing Address - Phone:830-377-1726
Mailing Address - Fax:210-257-8807
Practice Address - Street 1:4000 HORIZON HILL BLVD APT 2107
Practice Address - Street 2:2107
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-2227
Practice Address - Country:US
Practice Address - Phone:830-377-1726
Practice Address - Fax:210-257-8807
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-19
Last Update Date:2014-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11423101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)