Healthcare Provider Details

I. General information

NPI: 1205242005
Provider Name (Legal Business Name): REBECCA RACE LPC, LBS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2014
Last Update Date: 12/04/2024
Certification Date: 12/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 BRYDEN ST
PITTSTON PA
18640-3450
US

IV. Provider business mailing address

65 BRYDEN ST
PITTSTON PA
18640-3450
US

V. Phone/Fax

Practice location:
  • Phone: 570-225-9299
  • Fax: 570-225-9299
Mailing address:
  • Phone: 570-225-9299
  • Fax: 570-225-9299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC018017
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: