Provider Demographics
NPI:1962817080
Name:HALE, REBECKA SUZANE (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:REBECKA
Middle Name:SUZANE
Last Name:HALE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18254 LIVERNOIS AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48221-4214
Mailing Address - Country:US
Mailing Address - Phone:989-430-3083
Mailing Address - Fax:
Practice Address - Street 1:1194 MEADOWLARK
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-7619
Practice Address - Country:US
Practice Address - Phone:989-430-3083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-26
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010692271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical