Provider Demographics
NPI:1396038618
Name:REED, REBECCA A (LMSW, MSW)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:A
Last Name:REED
Suffix:
Gender:F
Credentials:LMSW, MSW
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:A
Other - Last Name:REED- HALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW, MSW
Mailing Address - Street 1:13448 COMMONWEALTH ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHGATE
Mailing Address - State:MI
Mailing Address - Zip Code:48195-1267
Mailing Address - Country:US
Mailing Address - Phone:734-486-3746
Mailing Address - Fax:
Practice Address - Street 1:14799 DIX TOLEDO RD
Practice Address - Street 2:
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195-2507
Practice Address - Country:US
Practice Address - Phone:734-324-8326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-19
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010910771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical