Healthcare Provider Details

I. General information

NPI: 1811817307
Provider Name (Legal Business Name): REBEKAH GRACCE CLONINGER MA, LPC, NCC, CCTP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7445 MONTICELLO RD APT 527A
COLUMBIA SC
29203-1519
US

IV. Provider business mailing address

7445 MONTICELLO RD APT 527A
COLUMBIA SC
29203-1519
US

V. Phone/Fax

Practice location:
  • Phone: 803-728-1415
  • Fax:
Mailing address:
  • Phone: 803-728-1415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number11209
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: