Basic Information
| Provider Information | |||||||||
| NPI: | 1104018001 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FLETCHER | ||||||||
| FirstName: | REBECCA | ||||||||
| MiddleName: | FAITH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 23406 CREST FOREST DRIVE | ||||||||
| Address2: | |||||||||
| City: | CRESTLINE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92325 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9093384689 | ||||||||
| FaxNumber: | 9093388230 | ||||||||
| Practice Location | |||||||||
| Address1: | 1669 N E ST | ||||||||
| Address2: | SAN BERNARDINO | ||||||||
| City: | SAN BERNARDINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 924054405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9098866737 | ||||||||
| FaxNumber: | 9098813871 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/14/2007 | ||||||||
| LastUpdateDate: | 08/14/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | IMF 54076 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.