Healthcare Provider Details

I. General information

NPI: 1952776312
Provider Name (Legal Business Name): REBECCA NEEDY LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2015
Last Update Date: 12/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4528 PLANK RD STE A
FREDERICKSBURG VA
22407-0141
US

IV. Provider business mailing address

4528 PLANK RD STE A
FREDERICKSBURG VA
22407-0141
US

V. Phone/Fax

Practice location:
  • Phone: 540-845-6940
  • Fax: 484-842-6053
Mailing address:
  • Phone: 540-845-6940
  • Fax: 484-842-6053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0701005339
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number0701005339
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701005339
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: