Provider Demographics
NPI:1366112013
Name:HENDRY, REBECKA LYNN (CADC)
Entity type:Individual
Prefix:
First Name:REBECKA
Middle Name:LYNN
Last Name:HENDRY
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 SHAKER RD
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:ME
Mailing Address - Zip Code:04039-6702
Mailing Address - Country:US
Mailing Address - Phone:207-312-0884
Mailing Address - Fax:
Practice Address - Street 1:16 SHAKER RD
Practice Address - Street 2:
Practice Address - City:GRAY
Practice Address - State:ME
Practice Address - Zip Code:04039-6702
Practice Address - Country:US
Practice Address - Phone:207-312-0884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-15
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL6949101YM0800X
MECAC7018101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health