Provider Demographics
NPI:1598485286
Name:ANDERSON, REBEKAH (MA, LLC, CAADC-D)
Entity type:Individual
Prefix:MS
First Name:REBEKAH
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:
Credentials:MA, LLC, CAADC-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4111 LILAC LN
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49685-7807
Mailing Address - Country:US
Mailing Address - Phone:231-645-7150
Mailing Address - Fax:
Practice Address - Street 1:4111 LILAC LN
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49685-7807
Practice Address - Country:US
Practice Address - Phone:316-457-1502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-01
Last Update Date:2025-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6451023031101YM0800X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health