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General NPI Number Information
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NPI Number | 1871867929
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Entity Type | Individual
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Provider Name | REBECCA E HALLAM LCSW-C
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Gender | Female
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Dates
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Enumeration Date | 03/06/2012
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Last Update Date | 03/06/2012
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Provider Practice Location Address
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Address Line | 19625 ISLANDER ST
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City | OLNEY
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State | MD
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Zip | 20832-1020
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Country | US
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Telephone | 301-337-7211
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 83343
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City | GAITHERSBURG
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State | MD
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Zip | 20883-3343
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Country | US
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Telephone | 301-337-7211
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Fax | 888-398-7137
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 09711
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License Number State | MD
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