Provider Demographics
NPI:1144310103
Name:GAINOR, DEBRA (MA, LLP)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:GAINOR
Suffix:
Gender:F
Credentials:MA, LLP
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:LEE
Other - Last Name:TOLLZIEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:49494 MAURICE DR
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48047-1750
Mailing Address - Country:US
Mailing Address - Phone:586-549-3788
Mailing Address - Fax:
Practice Address - Street 1:49494 MAURICE DR
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MI
Practice Address - Zip Code:48047-1750
Practice Address - Country:US
Practice Address - Phone:586-549-3788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2022-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6361001515103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist