Healthcare Provider Details

I. General information

NPI: 1396669396
Provider Name (Legal Business Name): REBECCA THIENEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

185 WOOSTER RD
SOUTHERN PINES NC
28387-2354
US

IV. Provider business mailing address

20 PRINCESS GATE DR
WHISPERING PINES NC
28327-9723
US

V. Phone/Fax

Practice location:
  • Phone: 910-585-9074
  • Fax:
Mailing address:
  • Phone: 910-585-9074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA22618
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: