Provider Demographics
NPI:1427168434
Name:BALAK, DEBORAH W (LCSW)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:W
Last Name:BALAK
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 1:4356 BONNEY RD
Mailing Address - Street 2:SUITE 2-101
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-1200
Mailing Address - Country:US
Mailing Address - Phone:757-498-1135
Mailing Address - Fax:757-498-7018
Practice Address - Street 1:4356 BONNEY RD
Practice Address - Street 2:SUITE 2-101
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-1200
Practice Address - Country:US
Practice Address - Phone:757-498-1135
Practice Address - Fax:757-498-7018
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904001517104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
098857OtherBCBS
VA89-45195Medicaid