Provider Demographics
NPI:1174662340
Name:HOLBROOK, REBECCA DAWN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:DAWN
Last Name:HOLBROOK
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 1:2072 CARR AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-5341
Mailing Address - Country:US
Mailing Address - Phone:901-272-7044
Mailing Address - Fax:
Practice Address - Street 1:7410 MEMPHIS ARLINGTON RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38135-1908
Practice Address - Country:US
Practice Address - Phone:901-252-7984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN45561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical