Healthcare Provider Details

I. General information

NPI: 1023235496
Provider Name (Legal Business Name): REBECCA LYNN DYKES LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: REBECCA LYNN BUSSMAN

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 11/16/2023
Certification Date: 11/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

226 YELLOW PINE CT
NICEVILLE FL
32578-2350
US

IV. Provider business mailing address

226 YELLOW PINE CT
NICEVILLE FL
32578-2350
US

V. Phone/Fax

Practice location:
  • Phone: 850-333-1394
  • Fax:
Mailing address:
  • Phone: 850-333-1394
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberSW 10307
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberSW 10307
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberSW 10307
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: