Provider Demographics
NPI:1891442653
Name:DAI'RE, DEBORAH (MS)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:DAI'RE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1860 WILMA RUDOLPH BLVD STE 111B
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-6750
Mailing Address - Country:US
Mailing Address - Phone:615-398-2123
Mailing Address - Fax:931-233-4544
Practice Address - Street 1:1860 WILMA RUDOLPH BLVD STE 111B
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-6750
Practice Address - Country:US
Practice Address - Phone:615-398-2123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-02
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6329101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty