Provider Demographics
NPI:1588974018
Name:DEMINCK, DEBRA K (LPCC)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:K
Last Name:DEMINCK
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:K
Other - Last Name:GEHRIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPCC
Mailing Address - Street 1:3105 ELM ST N
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58102-1740
Mailing Address - Country:US
Mailing Address - Phone:701-293-6762
Mailing Address - Fax:
Practice Address - Street 1:3105 ELM ST N
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58102-1740
Practice Address - Country:US
Practice Address - Phone:701-293-6762
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-18
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN271903101YP2500X
ND4777102195101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional