Provider Demographics
NPI:1740663285
Name:LIMBAUGH, REBECCA MARIE (BSW, MA, LLPC)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:MARIE
Last Name:LIMBAUGH
Suffix:
Gender:F
Credentials:BSW, MA, LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29300 POINTE O WOODS PL APT 107
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1238
Mailing Address - Country:US
Mailing Address - Phone:248-342-9983
Mailing Address - Fax:
Practice Address - Street 1:29300 POINTE O WOODS PL APT 107
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1238
Practice Address - Country:US
Practice Address - Phone:248-342-9983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-01
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI640101693101YP2500X
171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No171W00000XOther Service ProvidersContractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1980Medicaid
MI1980Medicaid