Healthcare Provider Details

I. General information

NPI: 1194900928
Provider Name (Legal Business Name): REBECCA ELLEN CREED LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2007
Last Update Date: 06/06/2026
Certification Date: 06/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4207 SUNNYSIDE RD
CAPE CHARLES VA
23310-3706
US

IV. Provider business mailing address

PO BOX 543
CAPE CHARLES VA
23310-0543
US

V. Phone/Fax

Practice location:
  • Phone: 757-695-0138
  • Fax:
Mailing address:
  • Phone: 757-695-0138
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904002185
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: