Healthcare Provider Details

I. General information

NPI: 1154364131
Provider Name (Legal Business Name): REBECCA A HALTERMAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBECCA ANN REDFEARN

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 08/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4208 SIX FORKS RD BLDG 1, SUITE 305 A
RALEIGH NC
27609-5735
US

IV. Provider business mailing address

21321 MARSH CREEK DR
ASHBURN VA
20148-4025
US

V. Phone/Fax

Practice location:
  • Phone: 800-632-6074
  • Fax: 866-341-7509
Mailing address:
  • Phone: 703-723-1459
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC005261
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: