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NPI Code Detail

MEDICARE: REBECCA ALEXANDRA FREDERICK

MEDICARE: REBECCA ALEXANDRA FREDERICK
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1275461287
Entity Type Code : Individual
Provider Name (Legal Business Name) : REBECCA ALEXANDRA FREDERICK
Provider Business Mailing Address
First Line : 700 OAKMOUND RD
Second Line :
City : CLARKSBURG
State : WV
Zip : 26301-9398
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 700 OAK MOUND RD
Second Line :
City : CLARKSBURG
State : WV
Zip : 26301-9398
Country : US
Telephone Number : 304-623-6330
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/11/2026
Last Update Date : 05/11/2026

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