Provider Demographics
NPI:1427620772
Name:DEITRICH, REBEKAH PHARE (LMHCA)
Entity type:Individual
Prefix:MRS
First Name:REBEKAH
Middle Name:PHARE
Last Name:DEITRICH
Suffix:
Gender:F
Credentials:LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:641 ANNIE ROSE LN NW
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110-2750
Mailing Address - Country:US
Mailing Address - Phone:603-289-9686
Mailing Address - Fax:
Practice Address - Street 1:18657 STATE HIGHWAY 305 NE STE 3
Practice Address - Street 2:
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-9184
Practice Address - Country:US
Practice Address - Phone:603-289-9686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-15
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC61192854101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health