Provider Demographics
NPI:1457733578
Name:LESTER-BLACK, REBECCA SUE (LPCC, LSW)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:SUE
Last Name:LESTER-BLACK
Suffix:
Gender:F
Credentials:LPCC, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5447 COUNTY ROAD 4
Mailing Address - Street 2:
Mailing Address - City:SWANTON
Mailing Address - State:OH
Mailing Address - Zip Code:43558-9716
Mailing Address - Country:US
Mailing Address - Phone:419-280-1470
Mailing Address - Fax:
Practice Address - Street 1:JOBST TOWER SUITE 640
Practice Address - Street 2:2109 HUGHES DRIVE
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606
Practice Address - Country:US
Practice Address - Phone:567-661-0505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-25
Last Update Date:2018-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.1700263101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health