Healthcare Provider Details

I. General information

NPI: 1295865301
Provider Name (Legal Business Name): REBECCA COMBS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 02/15/2023
Certification Date: 02/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 S MAIN CROSS ST
LOUISA KY
41230-1065
US

IV. Provider business mailing address

115 ROCKWOOD LN
HAZARD KY
41701-9415
US

V. Phone/Fax

Practice location:
  • Phone: 606-638-0938
  • Fax:
Mailing address:
  • Phone: 606-436-5761
  • Fax: 606-436-5797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number3833
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number5866
License Number StateKY
# 5
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number3833
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: