Provider Demographics
NPI:1932254901
Name:MCCORMICK, DEBORA M (MS, NCC, LPC)
Entity type:Individual
Prefix:
First Name:DEBORA
Middle Name:M
Last Name:MCCORMICK
Suffix:
Gender:F
Credentials:MS, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 VILLAGE WALK
Mailing Address - Street 2:SUITE 180C
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30132
Mailing Address - Country:US
Mailing Address - Phone:770-826-5542
Mailing Address - Fax:866-840-0590
Practice Address - Street 1:105 VILLAGE WALK
Practice Address - Street 2:SUITE 180C
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30132-5504
Practice Address - Country:US
Practice Address - Phone:770-826-5542
Practice Address - Fax:866-840-0590
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC003940101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1932254901Medicaid