Provider Demographics
NPI:1942779962
Name:JOANIS, REBECCA (LPC)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:JOANIS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:VANDENBOSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3500 NORTHCLIFFE RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-3667
Mailing Address - Country:US
Mailing Address - Phone:269-312-3001
Mailing Address - Fax:
Practice Address - Street 1:12557 RAVENWOOD DR
Practice Address - Street 2:
Practice Address - City:CHARDON
Practice Address - State:OH
Practice Address - Zip Code:44024-9009
Practice Address - Country:US
Practice Address - Phone:440-285-3568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-20
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1801544101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty