Provider Demographics
NPI:1427132372
Name:DOLL, REBECCA JULETTE (LCSW)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:JULETTE
Last Name:DOLL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11270 E. WAGON TRAIL ROAD
Mailing Address - Street 2:P.O. BOX 929
Mailing Address - City:EVANSVILLE
Mailing Address - State:WY
Mailing Address - Zip Code:82636
Mailing Address - Country:US
Mailing Address - Phone:307-234-6575
Mailing Address - Fax:
Practice Address - Street 1:123 W 1ST ST
Practice Address - Street 2:SUITE 675
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-2481
Practice Address - Country:US
Practice Address - Phone:307-265-0304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2008-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health