Provider Demographics
NPI:1558397711
Name:RABKA, JON EDWARD (MA, LPCC)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:EDWARD
Last Name:RABKA
Suffix:
Gender:M
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3505 CALLE CUERVO NW
Mailing Address - Street 2:APT. #338
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-9211
Mailing Address - Country:US
Mailing Address - Phone:505-306-9522
Mailing Address - Fax:
Practice Address - Street 1:1424 DEBORAH RD SE
Practice Address - Street 2:SUITE # 101
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-1058
Practice Address - Country:US
Practice Address - Phone:505-896-0928
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2017-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0076941101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)