Provider Demographics
NPI:1477755858
Name:JOHN, REBECCA MICHELLE (PHD, LPC, CDC-I)
Entity Type:Individual
Prefix:DR
First Name:REBECCA MICHELLE
Middle Name:
Last Name:JOHN
Suffix:
Gender:F
Credentials:PHD, LPC, CDC-I
Other - Prefix:DR
Other - First Name:REBECCA
Other - Middle Name:MICHELLE
Other - Last Name:JOHN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD, LPC, CDC-I
Mailing Address - Street 1:2441 BENTZEN CIR APT E28
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99517-3226
Mailing Address - Country:US
Mailing Address - Phone:907-317-8929
Mailing Address - Fax:
Practice Address - Street 1:2441 BENTZEN CIR APT E28
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99517-3226
Practice Address - Country:US
Practice Address - Phone:907-317-8929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK3245101YA0400X
AK393101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)