Provider Demographics
NPI:1922062595
Name:REBACK, DONALD KEANAN (PHD ABPP)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:KEANAN
Last Name:REBACK
Suffix:
Gender:M
Credentials:PHD ABPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:164 KIMBERLY AVE
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28804-3539
Mailing Address - Country:US
Mailing Address - Phone:828-252-7891
Mailing Address - Fax:
Practice Address - Street 1:1100 TUNNEL RD
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28805-2043
Practice Address - Country:US
Practice Address - Phone:828-298-7911
Practice Address - Fax:828-299-5992
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI981057103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service