Provider Demographics
NPI:1669961025
Name:MACIAS, REBECCA (APPC)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:MACIAS
Suffix:
Gender:F
Credentials:APPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 1/2 N GARDNER ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-5710
Mailing Address - Country:US
Mailing Address - Phone:805-304-1158
Mailing Address - Fax:
Practice Address - Street 1:2550 OVERLAND AVE STE 100
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-3346
Practice Address - Country:US
Practice Address - Phone:424-226-8337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-01
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2934101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor