=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437393220
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | REBEKKA LEE FREEMAN PSYD,LADC,CC.COND
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/24/2009
-----------------------------------------------------
Last Update Date | 04/24/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 37 EAST TROUT LN
-----------------------------------------------------
City | SWANVILLE
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04915-0284
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-338-6055
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 284
-----------------------------------------------------
City | BELFAST
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04915-0284
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-338-6055
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | LC956
-----------------------------------------------------
License Number State | ME
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | XL3225
-----------------------------------------------------
License Number State | ME
-----------------------------------------------------