Provider Demographics
NPI:1437701745
Name:REBECCA VAN DYKE, LMHC, LLC
Entity type:Organization
Organization Name:REBECCA VAN DYKE, LMHC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN DYKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-238-9674
Mailing Address - Street 1:100 CUMMINGS CTR STE 207P
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-6104
Mailing Address - Country:US
Mailing Address - Phone:978-238-9674
Mailing Address - Fax:978-910-0531
Practice Address - Street 1:100 CUMMINGS CTR STE 207P
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-6104
Practice Address - Country:US
Practice Address - Phone:978-238-9674
Practice Address - Fax:978-910-0531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-16
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)