Provider Demographics
NPI:1417272428
Name:RETTIG, ALAN R (LMHC)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:R
Last Name:RETTIG
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 BRIARWOOD DR
Mailing Address - Street 2:
Mailing Address - City:DEBARY
Mailing Address - State:FL
Mailing Address - Zip Code:32713-4376
Mailing Address - Country:US
Mailing Address - Phone:386-668-1504
Mailing Address - Fax:
Practice Address - Street 1:207 WHITE ST
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-3427
Practice Address - Country:US
Practice Address - Phone:863-683-9775
Practice Address - Fax:863-683-5515
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-01
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH2448101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health