Healthcare Provider Details

I. General information

NPI: 1982333837
Provider Name (Legal Business Name): REBECCA LUTTRELL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2022
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 KINCAID DR
TOCCOA FALLS GA
30598-9602
US

IV. Provider business mailing address

72 BEAVER BROOK DR
TOCCOA GA
30577-3939
US

V. Phone/Fax

Practice location:
  • Phone: 706-524-8702
  • Fax:
Mailing address:
  • Phone: 770-490-9664
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW010166
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number107903
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: