Provider Demographics
NPI:1073010815
Name:RICH-FIDLER, REBECCA FAITH (MA, LPCC, LICDC)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:FAITH
Last Name:RICH-FIDLER
Suffix:
Gender:F
Credentials:MA, LPCC, LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30811 LAKE LOGAN RD
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:OH
Mailing Address - Zip Code:43138-9546
Mailing Address - Country:US
Mailing Address - Phone:740-603-6165
Mailing Address - Fax:740-777-4014
Practice Address - Street 1:30811 LAKE LOGAN RD
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:OH
Practice Address - Zip Code:43138-9546
Practice Address - Country:US
Practice Address - Phone:740-603-6165
Practice Address - Fax:740-777-4014
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-09
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLICDC.161951101YA0400X
OHE.1901547101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)