Healthcare Provider Details

I. General information

NPI: 1922062595
Provider Name (Legal Business Name): DONALD KEANAN REBACK PHD ABPP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 TUNNEL RD
ASHEVILLE NC
28805-2043
US

IV. Provider business mailing address

164 KIMBERLY AVE
ASHEVILLE NC
28804-3539
US

V. Phone/Fax

Practice location:
  • Phone: 828-298-7911
  • Fax: 828-299-5992
Mailing address:
  • Phone: 828-252-7891
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number981057
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: