Provider Demographics
NPI:1538219316
Name:SAIDLA, DEBIE D (PHD)
Entity type:Individual
Prefix:
First Name:DEBIE
Middle Name:D
Last Name:SAIDLA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 N 20TH ST
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28557-4401
Mailing Address - Country:US
Mailing Address - Phone:252-515-4474
Mailing Address - Fax:
Practice Address - Street 1:805 N 20TH ST
Practice Address - Street 2:
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-4401
Practice Address - Country:US
Practice Address - Phone:252-515-4474
Practice Address - Fax:910-791-6890
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2012-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1936103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0428AOtherBCBSNC
NC6000786Medicaid
NC6000786Medicaid
P00343062Medicare PIN