Provider Demographics
NPI:1437669108
Name:LUPER, DEBORAH SUSAN (MA, CAC1)
Entity type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:SUSAN
Last Name:LUPER
Suffix:
Gender:F
Credentials:MA, CAC1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:39 SHOALS FERRY ROAD SE
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30161
Mailing Address - Country:US
Mailing Address - Phone:770-546-1129
Mailing Address - Fax:770-383-3228
Practice Address - Street 1:106 FORREST AVENUE
Practice Address - Street 2:A HEALING PLACE
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120
Practice Address - Country:US
Practice Address - Phone:770-383-3311
Practice Address - Fax:770-383-3228
Is Sole Proprietor?:No
Enumeration Date:2017-10-06
Last Update Date:2017-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3433101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)