Healthcare Provider Details

I. General information

NPI: 1134558372
Provider Name (Legal Business Name): CARA-LEIGH RECKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2013
Last Update Date: 07/11/2023
Certification Date: 07/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 JEFFERSON ST
LYNCHBURG VA
24504-1723
US

IV. Provider business mailing address

PO BOX 748465
ATLANTA GA
30374-8465
US

V. Phone/Fax

Practice location:
  • Phone: 855-284-7483
  • Fax:
Mailing address:
  • Phone: 855-284-7483
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMHC5000552
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: