Healthcare Provider Details

I. General information

NPI: 1205649258
Provider Name (Legal Business Name): REBECCA WADE HILL LPC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2025
Last Update Date: 05/06/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 S CARROLL RD
VILLA RICA GA
30180-2607
US

IV. Provider business mailing address

231 S CARROLL RD
VILLA RICA GA
30180-2607
US

V. Phone/Fax

Practice location:
  • Phone: 770-241-1065
  • Fax:
Mailing address:
  • Phone: 770-241-1065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: REBECCA WADE HILL
Title or Position: PROFESSIONAL COUNSELOR
Credential: LPC
Phone: 770-241-1065