Healthcare Provider Details

I. General information

NPI: 1154230928
Provider Name (Legal Business Name): LAUREN REBA-HARRELSON, PH.D., LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2026
Last Update Date: 09/05/2026
Certification Date: 09/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 HARPER RD
MCDONOUGH GA
30252-4958
US

IV. Provider business mailing address

507 HARPER RD
MCDONOUGH GA
30252-4958
US

V. Phone/Fax

Practice location:
  • Phone: 706-913-6115
  • Fax:
Mailing address:
  • Phone: 706-913-6115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. LAUREN EVELYN REBA-HARRELSON
Title or Position: PSYCHOLOGIST
Credential: PH.D.
Phone: 919-923-2119