Provider Demographics
NPI:1942354089
Name:CORRIN, DEBRA KAY (MA-ABS)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:KAY
Last Name:CORRIN
Suffix:
Gender:F
Credentials:MA-ABS
Other - Prefix:
Other - First Name:DEBY
Other - Middle Name:
Other - Last Name:SOUTHWICK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8490 MUKILTEO SPEEDWAY
Mailing Address - Street 2:
Mailing Address - City:MUKILTEO
Mailing Address - State:WA
Mailing Address - Zip Code:98275-3206
Mailing Address - Country:US
Mailing Address - Phone:425-347-9097
Mailing Address - Fax:425-356-6515
Practice Address - Street 1:8490 MUKILTEO SPEEDWAY
Practice Address - Street 2:
Practice Address - City:MUKILTEO
Practice Address - State:WA
Practice Address - Zip Code:98275-3206
Practice Address - Country:US
Practice Address - Phone:425-347-9097
Practice Address - Fax:425-356-6515
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00004555101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA91-1658365OtherTAX ID