Basic Information
Provider Information
NPI: 1003003245
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DOREAU
FirstName: REBEKAH
MiddleName: GOOD
NamePrefix: MRS.
NameSuffix:  
Credential: M.A.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 6110 SHALLOWFORD RD
Address2: SUITE B
City: CHATTANOOGA
State: TN
PostalCode: 374211894
CountryCode: US
TelephoneNumber: 8882914357
FaxNumber: 4232966384
Practice Location
Address1: 6110 SHALLOWFORD RD
Address2: SUITE B
City: CHATTANOOGA
State: TN
PostalCode: 374211894
CountryCode: US
TelephoneNumber: 8882914357
FaxNumber: 4232966384
Other Information
ProviderEnumerationDate: 10/02/2007
LastUpdateDate: 01/03/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800X  Y Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


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