Provider Demographics
NPI:1528546439
Name:REBIRTH FAMILY CARE SERVICES
Entity Type:Organization
Organization Name:REBIRTH FAMILY CARE SERVICES
Other - Org Name:REBIRTH COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:DIONNE
Authorized Official - Last Name:DUDLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCDC
Authorized Official - Phone:469-608-0295
Mailing Address - Street 1:2823 E ILLINOIS AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75216-3421
Mailing Address - Country:US
Mailing Address - Phone:469-608-0295
Mailing Address - Fax:
Practice Address - Street 1:2823 E ILLINOIS AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75216-3421
Practice Address - Country:US
Practice Address - Phone:469-608-0295
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-02
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14398101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty