Basic Information
| Provider Information | |||||||||
| NPI: | 1558397711 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RABKA | ||||||||
| FirstName: | JON | ||||||||
| MiddleName: | EDWARD | ||||||||
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| Credential: | MA, LPCC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3505 CALLE CUERVO NW | ||||||||
| Address2: | APT. #338 | ||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871149211 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5053069522 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1424 DEBORAH RD SE | ||||||||
| Address2: | SUITE # 101 | ||||||||
| City: | RIO RANCHO | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871241058 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5058960928 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2006 | ||||||||
| LastUpdateDate: | 07/26/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 0076941 | NM | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YM0800X | 0076941 | NM | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.