Provider Demographics
NPI:1760273726
Name:DIDEUM, REBECCA (MT-BC)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:DIDEUM
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8117 COLQUITT RD APT F
Mailing Address - Street 2:
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30350-5917
Mailing Address - Country:US
Mailing Address - Phone:757-647-1563
Mailing Address - Fax:
Practice Address - Street 1:407 HARDSCRABBLE RD
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-1417
Practice Address - Country:US
Practice Address - Phone:224-467-3669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-16
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT000141225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist