Provider Demographics
NPI:1194379313
Name:DESS, REBEKAH (DSW, LCSW)
Entity type:Individual
Prefix:
First Name:REBEKAH
Middle Name:
Last Name:DESS
Suffix:
Gender:F
Credentials:DSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4011 BEATLINE RD STE 9
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:MS
Mailing Address - Zip Code:39560-4138
Mailing Address - Country:US
Mailing Address - Phone:228-574-5628
Mailing Address - Fax:228-367-4846
Practice Address - Street 1:4011 BEATLINE RD STE 9
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:MS
Practice Address - Zip Code:39560-4138
Practice Address - Country:US
Practice Address - Phone:228-574-5628
Practice Address - Fax:228-367-4846
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-25
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC8723104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty