Provider Demographics
NPI:1235805052
Name:REBIRTH REHABILITATION COUNSELING LLC
Entity type:Organization
Organization Name:REBIRTH REHABILITATION COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIEF THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:HARRIETTE
Authorized Official - Middle Name:RAYSHEEN
Authorized Official - Last Name:WADE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC-S
Authorized Official - Phone:225-303-4897
Mailing Address - Street 1:301 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70801-1919
Mailing Address - Country:US
Mailing Address - Phone:225-303-4897
Mailing Address - Fax:225-612-6445
Practice Address - Street 1:6418 NESTING DR
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-8645
Practice Address - Country:US
Practice Address - Phone:225-303-4897
Practice Address - Fax:225-612-6445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-20
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty