Healthcare Provider Details

I. General information

NPI: 1750145512
Provider Name (Legal Business Name): REBECCA SHAWNITA TOMBLIN BA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2024
Last Update Date: 02/12/2024
Certification Date: 02/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 UPPER KANAWHA VALLEY WAY
CHEYLAN WV
25506
US

IV. Provider business mailing address

PO BOX 241
BRANCHLAND WV
25506
US

V. Phone/Fax

Practice location:
  • Phone: 304-553-2034
  • Fax:
Mailing address:
  • Phone: 304-223-0796
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: