Healthcare Provider Details

I. General information

NPI: 1487742052
Provider Name (Legal Business Name): REBECCA ANDREA BEATON PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBECCA ANDREA BROGAN PHD

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1640 POWERS FERRY RD SE BUILDING 9, SUITE 100
MARIETTA GA
30067-5491
US

IV. Provider business mailing address

1640 POWERS FERRY RD SE BUILDING 9, SUITE 100
MARIETTA GA
30067-5491
US

V. Phone/Fax

Practice location:
  • Phone: 770-953-0080
  • Fax: 770-953-0031
Mailing address:
  • Phone: 770-953-0080
  • Fax: 770-953-0031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPSY002789
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: