Provider Demographics
NPI:1164239687
Name:ITTNER, REBECCA A (APC, NCC)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:A
Last Name:ITTNER
Suffix:
Gender:F
Credentials:APC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 W PIKE ST STE 4
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-4896
Mailing Address - Country:US
Mailing Address - Phone:470-236-9864
Mailing Address - Fax:
Practice Address - Street 1:802 LARRY LN
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-4819
Practice Address - Country:US
Practice Address - Phone:404-458-7615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-17
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor