Healthcare Provider Details

I. General information

NPI: 1760345540
Provider Name (Legal Business Name): REBEKAH LAUREN WHALEN LCMHC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5040 NEW CENTRE DR
WILMINGTON NC
28403-1614
US

IV. Provider business mailing address

143 WINDY HILLS DR
WILMINGTON NC
28409-4331
US

V. Phone/Fax

Practice location:
  • Phone: 704-292-9191
  • Fax: 910-392-9559
Mailing address:
  • Phone: 704-292-9191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberA22319
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: