Healthcare Provider Details

I. General information

NPI: 1023063211
Provider Name (Legal Business Name): REBEKAH THOMPSON M.A ,HSP-PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 11/19/2020
Certification Date: 11/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

616 E MARION ST
SHELBY NC
28150-4618
US

IV. Provider business mailing address

616 E MARION ST
SHELBY NC
28150-4618
US

V. Phone/Fax

Practice location:
  • Phone: 704-482-6776
  • Fax: 704-482-8640
Mailing address:
  • Phone: 704-482-6776
  • Fax: 704-482-8640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1585
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: