Provider Demographics
NPI:1962842765
Name:EMMENECKER, REBECCA S (MA, BSW, LLPC, CAADC)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:S
Last Name:EMMENECKER
Suffix:
Gender:F
Credentials:MA, BSW, LLPC, CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 HANDY DR
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-3512
Mailing Address - Country:US
Mailing Address - Phone:989-316-1237
Mailing Address - Fax:989-401-7509
Practice Address - Street 1:2084 HEMMETER RD
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-3943
Practice Address - Country:US
Practice Address - Phone:989-401-7506
Practice Address - Fax:989-401-7509
Is Sole Proprietor?:No
Enumeration Date:2013-06-26
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401008317101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)