Provider Demographics
NPI:1548505159
Name:SHEETZ, REBECCA SUE (MA, LAPC)
Entity type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:SUE
Last Name:SHEETZ
Suffix:
Gender:F
Credentials:MA, LAPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6020 DAWSON BLVD STE I
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30093-1259
Mailing Address - Country:US
Mailing Address - Phone:770-662-0249
Mailing Address - Fax:
Practice Address - Street 1:6020 DAWSON BLVD STE I
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093-1259
Practice Address - Country:US
Practice Address - Phone:770-662-0249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-07
Last Update Date:2012-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC 003140101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health