Provider Demographics
NPI:1093995961
Name:FAULKNER, REBECCA P (LCPC)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:P
Last Name:FAULKNER
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:PIETERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:635 S 2ND ST
Mailing Address - Street 2:
Mailing Address - City:DEKALB
Mailing Address - State:IL
Mailing Address - Zip Code:60115-4166
Mailing Address - Country:US
Mailing Address - Phone:931-538-8107
Mailing Address - Fax:
Practice Address - Street 1:12 HEALTH SERVICES DR
Practice Address - Street 2:
Practice Address - City:DEKALB
Practice Address - State:IL
Practice Address - Zip Code:60115-9637
Practice Address - Country:US
Practice Address - Phone:815-756-4875
Practice Address - Fax:815-756-2944
Is Sole Proprietor?:No
Enumeration Date:2007-11-08
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional