Healthcare Provider Details

I. General information

NPI: 1659843555
Provider Name (Legal Business Name): REBIRTH COUNSELING AND THERAPY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2018
Last Update Date: 03/22/2024
Certification Date: 03/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26300 CEDAR RD STE 1105
BEACHWOOD OH
44122-1190
US

IV. Provider business mailing address

16781 CHAGRIN BLVD STE 436
SHAKER HEIGHTS OH
44120-3721
US

V. Phone/Fax

Practice location:
  • Phone: 216-200-5433
  • Fax: 888-745-5166
Mailing address:
  • Phone: 216-200-5433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MRS. ANGELIA WORLEY
Title or Position: OWNER/ PROVIDER
Credential: LPCC
Phone: 216-200-5433