Healthcare Provider Details

I. General information

NPI: 1164239687
Provider Name (Legal Business Name): REBECCA A MAFFEY LPC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2024
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 KENTUCKY ST # 185
SCOTTDALE GA
30079-1124
US

IV. Provider business mailing address

610 KENTUCKY ST # 185
SCOTTDALE GA
30079-1124
US

V. Phone/Fax

Practice location:
  • Phone: 678-679-9805
  • Fax:
Mailing address:
  • Phone: 678-679-9805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC016704
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: