Provider Demographics
NPI:1902258288
Name:SHRECK, REBECCA G (LISW, LCDCIII)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:G
Last Name:SHRECK
Suffix:
Gender:F
Credentials:LISW, LCDCIII
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:G
Other - Last Name:GEHRON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2029 NORTHCREEK DR
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45322-2245
Mailing Address - Country:US
Mailing Address - Phone:937-390-2121
Mailing Address - Fax:
Practice Address - Street 1:2029 NORTHCREEK DR
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:OH
Practice Address - Zip Code:45322-2245
Practice Address - Country:US
Practice Address - Phone:937-390-2121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-11
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLCDCIII.161419101YA0400X
OHS1600343104100000X
OHI.18012901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker