Healthcare Provider Details

I. General information

NPI: 1558173831
Provider Name (Legal Business Name): REBECCA RAUB LGPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2025
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5022 CAMPBELL BLVD STE L-M
NOTTINGHAM MD
21236-4969
US

IV. Provider business mailing address

5022 CAMPBELL BLVD STE L-M
NOTTINGHAM MD
21236-4969
US

V. Phone/Fax

Practice location:
  • Phone: 443-442-1568
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLGP18235
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: