Healthcare Provider Details

I. General information

NPI: 1407775679
Provider Name (Legal Business Name): REBECCA POLEGA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 PARKER LN STE A
PINEHURST NC
28374-7919
US

IV. Provider business mailing address

538 N PRINCE HENRY WAY
CAMERON NC
28326-5075
US

V. Phone/Fax

Practice location:
  • Phone: 919-285-4802
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number20880A
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: