Provider Demographics
NPI:1285912519
Name:ANNE, REBECCA (LCSW, MDIV)
Entity type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:
Last Name:ANNE
Suffix:
Gender:F
Credentials:LCSW, MDIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 W HILL ST
Mailing Address - Street 2:SUITE 2C
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-4362
Mailing Address - Country:US
Mailing Address - Phone:678-827-3456
Mailing Address - Fax:
Practice Address - Street 1:321 W HILL ST
Practice Address - Street 2:SUITE 2C
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-4362
Practice Address - Country:US
Practice Address - Phone:678-827-3456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-03
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0042791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical