Healthcare Provider Details

I. General information

NPI: 1548993348
Provider Name (Legal Business Name): REBECCA W EWELL LCSW PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2022
Last Update Date: 07/11/2022
Certification Date: 07/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 S COLLEGE AVE
SALEM VA
24153-5165
US

IV. Provider business mailing address

5770 BLACKSBURG RD
CATAWBA VA
24070-2314
US

V. Phone/Fax

Practice location:
  • Phone: 540-354-3898
  • Fax: 540-387-3988
Mailing address:
  • Phone: 540-354-3898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MS. REBECCA W EWELL
Title or Position: LCSW
Credential: LCSW
Phone: 540-354-3898