Healthcare Provider Details

I. General information

NPI: 1568069052
Provider Name (Legal Business Name): REBECA CARVAJAL VALDES LCMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2020
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 N TRYON ST STE L88B
CHARLOTTE NC
28202-2222
US

IV. Provider business mailing address

4931 OAK PASTURE LN
CHARLOTTE NC
28269-1355
US

V. Phone/Fax

Practice location:
  • Phone: 704-659-1481
  • Fax:
Mailing address:
  • Phone: 202-600-1608
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number17920
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: