Healthcare Provider Details

I. General information

NPI: 1881663516
Provider Name (Legal Business Name): REBECCA A COTE LPC, ADS
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 SHENANDOAH AVE NW
ROANOKE VA
24016-2221
US

IV. Provider business mailing address

301 ELM AVENUE SW
ROANOKE VA
24016
US

V. Phone/Fax

Practice location:
  • Phone: 540-344-6208
  • Fax: 540-344-9112
Mailing address:
  • Phone: 540-345-9841
  • Fax: 540-527-2900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701003756
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: