Healthcare Provider Details

I. General information

NPI: 1174247266
Provider Name (Legal Business Name): REBEKAH SHILLING CCHW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2022
Last Update Date: 10/03/2022
Certification Date: 10/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1508 CRAPPS AVE
WEST COLUMBIA SC
29169-5508
US

IV. Provider business mailing address

1508 CRAPPS AVE
WEST COLUMBIA SC
29169-5508
US

V. Phone/Fax

Practice location:
  • Phone: 803-543-2347
  • Fax:
Mailing address:
  • Phone: 803-543-2347
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number312030
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: