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General NPI Number Information
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NPI Number | 1013303205
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Entity Type | Individual
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Provider Name | REBECCA PROVOST LPC
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Gender | Female
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Dates
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Enumeration Date | 04/14/2015
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Last Update Date | 04/14/2015
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Provider Practice Location Address
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Address Line | 921 FIRST COLONIAL RD STE 1711
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City | VIRGINIA BEACH
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State | VA
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Zip | 23454-3167
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Country | US
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Telephone | 757-932-8057
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Fax |
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Provider Business Mailing Address
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Address Line | 3400 ARCHER CT
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City | VIRGINIA BEACH
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State | VA
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Zip | 23452-5911
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Country | US
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Telephone | 910-526-1279
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0701005979
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License Number State | VA
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