Provider Demographics
NPI:1700326063
Name:DAVIS, REBECCA K (MSSA, LSW)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:K
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MSSA, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11565 PEARL RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:STRONGSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44136-3356
Mailing Address - Country:US
Mailing Address - Phone:440-846-0862
Mailing Address - Fax:440-846-0890
Practice Address - Street 1:11565 PEARL RD
Practice Address - Street 2:SUITE 200
Practice Address - City:STRONGSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44136-3356
Practice Address - Country:US
Practice Address - Phone:440-846-0862
Practice Address - Fax:440-846-0890
Is Sole Proprietor?:No
Enumeration Date:2017-03-06
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS1450700101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health