Provider Demographics
NPI:1982304499
Name:POTENBERG, REBECCA L (MS, T-LMHC, LPC)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:L
Last Name:POTENBERG
Suffix:
Gender:F
Credentials:MS, T-LMHC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3706 19TH AVE
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-4407
Mailing Address - Country:US
Mailing Address - Phone:708-268-3909
Mailing Address - Fax:
Practice Address - Street 1:2800 EASTERN AVE
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52803-2012
Practice Address - Country:US
Practice Address - Phone:563-326-6431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-06
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA115404101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health