Provider Demographics
NPI:1902068406
Name:FARQUHAR, REBECCA JA (CDP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:JA
Last Name:FARQUHAR
Suffix:
Gender:F
Credentials:CDP
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:JA
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CDP
Mailing Address - Street 1:PO BOX 2429
Mailing Address - Street 2:1055 9TH AVE STE D
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-8486
Mailing Address - Country:US
Mailing Address - Phone:360-575-3316
Mailing Address - Fax:360-397-8251
Practice Address - Street 1:1044 11TH AVE
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-2506
Practice Address - Country:US
Practice Address - Phone:360-575-3316
Practice Address - Fax:360-423-7813
Is Sole Proprietor?:No
Enumeration Date:2008-06-26
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP60132646101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)