Provider Demographics
NPI:1356491047
Name:REMBERT, MARY THERESA (LPCC)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:THERESA
Last Name:REMBERT
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:MRS
Other - First Name:MARY
Other - Middle Name:THERESA
Other - Last Name:REMBERT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPCC
Mailing Address - Street 1:61 E MAIN STREET
Mailing Address - Street 2:SUITE 3
Mailing Address - City:WILMINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:45177
Mailing Address - Country:US
Mailing Address - Phone:937-383-2282
Mailing Address - Fax:937-383-4129
Practice Address - Street 1:61 E MAIN STREET
Practice Address - Street 2:SUITE 3
Practice Address - City:WILMINGTON
Practice Address - State:OH
Practice Address - Zip Code:45177
Practice Address - Country:US
Practice Address - Phone:937-383-2282
Practice Address - Fax:937-383-4129
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0002258101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000065461OtherANTHEM