Provider Demographics
NPI:1992115679
Name:DIONNE, REBECCA L (LLPC)
Entity type:Individual
Prefix:
First Name:REBECCA L
Middle Name:
Last Name:DIONNE
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 RIVER ST STE 100
Mailing Address - Street 2:P.O. BOX 354
Mailing Address - City:BOYNE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49712-1234
Mailing Address - Country:US
Mailing Address - Phone:231-675-6937
Mailing Address - Fax:855-488-0824
Practice Address - Street 1:101 RIVER STREET, SUITE 100
Practice Address - Street 2:
Practice Address - City:BOYNE CITY
Practice Address - State:MI
Practice Address - Zip Code:49712
Practice Address - Country:US
Practice Address - Phone:231-675-6937
Practice Address - Fax:855-488-0824
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-02
Last Update Date:2014-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401011600101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional