Healthcare Provider Details

I. General information

NPI: 1508403940
Provider Name (Legal Business Name): REBECCA CATHERINE PERKINS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2019
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1058 FOX DEN TRL
SOUTH BOSTON VA
24592-6330
US

IV. Provider business mailing address

1058 FOX DEN TRL
SOUTH BOSTON VA
24592-6330
US

V. Phone/Fax

Practice location:
  • Phone: 703-772-3439
  • Fax:
Mailing address:
  • Phone: 703-772-3439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0701008629
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: