Provider Demographics
NPI:1144524547
Name:DENNISON, REBECCA ELIZABETH (MA MFT)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:ELIZABETH
Last Name:DENNISON
Suffix:
Gender:F
Credentials:MA MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:923 WINDRIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-7908
Mailing Address - Country:US
Mailing Address - Phone:760-525-2482
Mailing Address - Fax:
Practice Address - Street 1:325 CARLSBAD VILLAGE DR
Practice Address - Street 2:F-2
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-2928
Practice Address - Country:US
Practice Address - Phone:760-525-2482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-29
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC33064106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist