Basic Information
| Provider Information | |||||||||
| NPI: | 1891007076 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WALTERS | ||||||||
| FirstName: | REBECCA | ||||||||
| MiddleName: | STRONG | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2437 DUNDEE CT | ||||||||
| Address2: | |||||||||
| City: | SAN LEANDRO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945776009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5103510902 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 13666 E 14TH ST | ||||||||
| Address2: | |||||||||
| City: | SAN LEANDRO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945782538 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5103575515 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2010 | ||||||||
| LastUpdateDate: | 07/05/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | IMF 61534 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.