Provider Demographics
NPI:1295079952
Name:YAROSH, REBECCA ELLIS (LCSW)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:ELLIS
Last Name:YAROSH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 STEPPENSTONE BLVD
Mailing Address - Street 2:
Mailing Address - City:LIMESTONE
Mailing Address - State:TN
Mailing Address - Zip Code:37681-2740
Mailing Address - Country:US
Mailing Address - Phone:423-257-6054
Mailing Address - Fax:
Practice Address - Street 1:110 STEPPENSTONE BLVD
Practice Address - Street 2:
Practice Address - City:LIMESTONE
Practice Address - State:TN
Practice Address - Zip Code:37681-2740
Practice Address - Country:US
Practice Address - Phone:423-257-8600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-19
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN42991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical