Healthcare Provider Details

I. General information

NPI: 1386673929
Provider Name (Legal Business Name): REBECCA ANN HARRINGTON LLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 W 5TH AVE
FLINT MI
48503-2445
US

IV. Provider business mailing address

701 S LEROY ST
FENTON MI
48430-2156
US

V. Phone/Fax

Practice location:
  • Phone: 810-424-6088
  • Fax: 810-257-3794
Mailing address:
  • Phone: 810-240-1867
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6301007865
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: