Healthcare Provider Details

I. General information

NPI: 1417732298
Provider Name (Legal Business Name): REBECCA GRACE SAMELSON MA, LPC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MRS. BECCA WEBB

II. Dates (important events)

Enumeration Date: 08/29/2023
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5050 RESEARCH CT STE 800
SUWANEE GA
30024-6606
US

IV. Provider business mailing address

5050 RESEARCH CT STE 800
SUWANEE GA
30024-6606
US

V. Phone/Fax

Practice location:
  • Phone: 678-749-7600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC016506
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: