Provider Demographics
NPI:1154120400
Name:HARRISON, REBECCA RAE (LBSW)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:RAE
Last Name:HARRISON
Suffix:
Gender:
Credentials:LBSW
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:RAE
Other - Last Name:HARRISON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LBSW
Mailing Address - Street 1:525 N 9TH ST
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-4510
Mailing Address - Country:US
Mailing Address - Phone:701-751-2887
Mailing Address - Fax:
Practice Address - Street 1:525 N 9TH ST
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-4510
Practice Address - Country:US
Practice Address - Phone:701-751-2887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-10
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND6548104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker