Healthcare Provider Details

I. General information

NPI: 1891305611
Provider Name (Legal Business Name): REBECCA IVY COHEN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2020
Last Update Date: 07/06/2023
Certification Date: 07/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1080 FIRST COLONIAL RD STE 200
VIRGINIA BEACH VA
23454-2406
US

IV. Provider business mailing address

1080 FIRST COLONIAL RD STE 200
VIRGINIA BEACH VA
23454-2406
US

V. Phone/Fax

Practice location:
  • Phone: 757-395-6070
  • Fax:
Mailing address:
  • Phone: 757-395-6070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701009735
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: