Healthcare Provider Details

I. General information

NPI: 1306573647
Provider Name (Legal Business Name): REBECCA SLOAN HARRILL LCMHC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2022
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5911 DWAYNE STARNES DR
HICKORY NC
28602-8916
US

IV. Provider business mailing address

200 E 2ND AVE
GASTONIA NC
28052-4358
US

V. Phone/Fax

Practice location:
  • Phone: 828-294-2020
  • Fax:
Mailing address:
  • Phone: 704-874-1904
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number17924
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: