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Organization
REBIRTH COUNSELING, PLLC
Active
Organization
REBIRTH COUNSELING, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CRYSTAL DIONNE DUDLEY LPC, LCDC (OWNER)
(469) 608-0295
Entity
Organization
Contact information
Practice address
1100 STONE RD STE 103, KILGORE, TX 75662-5494
(469) 608-0295
(903) 913-7274
Mailing address
1100 STONE RD STE 103, KILGORE, TX 75662-5494
(469) 608-0295
(903) 913-7274
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YP2500X
Professional Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3921009-01
—
TX
Enumeration date
01/10/2020
Last updated
01/10/2020
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