Provider Demographics
NPI:1033570882
Name:DAVIS, REBECCA L (LPC-IT, SAC)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:L
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LPC-IT, SAC
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:L
Other - Last Name:KNOX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:903 MINERAL POINT AVE
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53548-2970
Mailing Address - Country:US
Mailing Address - Phone:608-756-6530
Mailing Address - Fax:608-756-6564
Practice Address - Street 1:903 MINERAL POINT AVE
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53548-2970
Practice Address - Country:US
Practice Address - Phone:608-756-6530
Practice Address - Fax:608-756-6564
Is Sole Proprietor?:No
Enumeration Date:2016-03-08
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2654-226101YP2500X
WI16081-131101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1033570882Medicaid