Provider Demographics
NPI:1528305935
Name:DEBORAH JUDITH INC
Entity type:Organization
Organization Name:DEBORAH JUDITH INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON-ROSALES
Authorized Official - Suffix:
Authorized Official - Credentials:LCDC
Authorized Official - Phone:210-822-9493
Mailing Address - Street 1:410 S MAIN AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78204-1128
Mailing Address - Country:US
Mailing Address - Phone:210-822-9493
Mailing Address - Fax:210-822-8733
Practice Address - Street 1:410 S MAIN AVE STE 201
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78204-1128
Practice Address - Country:US
Practice Address - Phone:210-822-9493
Practice Address - Fax:210-822-8733
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DEBORAH JUDITH INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-01-07
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10217101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty