Provider Demographics
NPI:1285817478
Name:LEWIS, REBECCA JO-RADEMACHER (MA, LPC, CAADC, SST)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:JO-RADEMACHER
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MA, LPC, CAADC, SST
Other - Prefix:MS
Other - First Name:REBECCA
Other - Middle Name:JO
Other - Last Name:RADEMACHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 2147
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48161
Mailing Address - Country:US
Mailing Address - Phone:734-770-0845
Mailing Address - Fax:844-272-7476
Practice Address - Street 1:114 E ELM AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162-2649
Practice Address - Country:US
Practice Address - Phone:734-770-0845
Practice Address - Fax:844-272-7476
Is Sole Proprietor?:No
Enumeration Date:2007-12-11
Last Update Date:2023-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401010301101YA0400X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2604097Medicaid
MIOP23520Medicare PIN