Provider Demographics
NPI:1861724528
Name:DEBLAKER, LORI M (LCSW)
Entity type:Individual
Prefix:MS
First Name:LORI
Middle Name:M
Last Name:DEBLAKER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 DULWICH WAY
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27527-3339
Mailing Address - Country:US
Mailing Address - Phone:919-585-4401
Mailing Address - Fax:919-800-3155
Practice Address - Street 1:19 DULWICH WAY
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27527-3339
Practice Address - Country:US
Practice Address - Phone:919-585-4401
Practice Address - Fax:919-800-3155
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-05
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0091611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical