Provider Demographics
NPI:1699145755
Name:COFFEY, REBECCA MICHELLE (APCC, AMFT)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:MICHELLE
Last Name:COFFEY
Suffix:
Gender:F
Credentials:APCC, AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2380 SALVIO ST STE 301
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-2143
Mailing Address - Country:US
Mailing Address - Phone:925-692-0090
Mailing Address - Fax:
Practice Address - Street 1:2380 SALVIO ST STE 301
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-2143
Practice Address - Country:US
Practice Address - Phone:925-692-0090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-01
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAPCC5195101YP2500X
CAAMFT107929101Y00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAPCC5195OtherBBS
CAAMFT107929OtherBBS