Provider Demographics
NPI:1386389484
Name:HANCOCK, DEBRA DONESE (LCMHCA)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:DONESE
Last Name:HANCOCK
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18616 NANTZ RD
Mailing Address - Street 2:
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-8618
Mailing Address - Country:US
Mailing Address - Phone:614-406-4604
Mailing Address - Fax:
Practice Address - Street 1:134 W MATTHEWS ST
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-1305
Practice Address - Country:US
Practice Address - Phone:704-708-4605
Practice Address - Fax:704-469-5807
Is Sole Proprietor?:No
Enumeration Date:2022-05-03
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA17475101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health