Healthcare Provider Details

I. General information

NPI: 1679709620
Provider Name (Legal Business Name): REBECCA J DILLER LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2009
Last Update Date: 08/06/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 S MAIN ST
ADA OH
45810-6000
US

IV. Provider business mailing address

2421 ALLENTOWN RD
LIMA OH
45805-1711
US

V. Phone/Fax

Practice location:
  • Phone: 419-604-3372
  • Fax:
Mailing address:
  • Phone: 419-225-5238
  • Fax: 419-222-1579

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE0003474
License Number StateOH

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: