Basic Information
| Provider Information | |||||||||
| NPI: | 1457733578 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LESTER-BLACK | ||||||||
| FirstName: | REBECCA | ||||||||
| MiddleName: | SUE | ||||||||
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| Credential: | LPCC, LSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5447 COUNTY ROAD 4 | ||||||||
| Address2: | |||||||||
| City: | SWANTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 435589716 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4192801470 | ||||||||
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| Practice Location | |||||||||
| Address1: | JOBST TOWER SUITE 640 | ||||||||
| Address2: | 2109 HUGHES DRIVE | ||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 43606 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5676610505 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2015 | ||||||||
| LastUpdateDate: | 01/31/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | E.1700263 | OH | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.