Provider Demographics
NPI:1679703300
Name:REID, REBEKAH (LMC/CSAC)
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:
Last Name:REID
Suffix:
Gender:F
Credentials:LMC/CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 555
Mailing Address - Street 2:
Mailing Address - City:KAPAA
Mailing Address - State:HI
Mailing Address - Zip Code:96746-0555
Mailing Address - Country:US
Mailing Address - Phone:808-823-7007
Mailing Address - Fax:808-823-7008
Practice Address - Street 1:4-1054 KUHIO HWY
Practice Address - Street 2:
Practice Address - City:KAPAA
Practice Address - State:HI
Practice Address - Zip Code:96746-1626
Practice Address - Country:US
Practice Address - Phone:808-823-7007
Practice Address - Fax:808-823-7008
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-15
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI133207101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)