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NPI Code Detail

MEDICARE: REBECCA D MATTINGLY LPC, LCAS

MEDICARE: REBECCA D MATTINGLY LPC, LCAS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) CounselorLCAS-3256NC
2101YP2500XProfessional Counselor10421NC

General Provider Information

NPI Number : 1154675031
Entity Type Code : Individual
Provider Name (Legal Business Name) : REBECCA D MATTINGLY LPC, LCAS
Provider Business Mailing Address
First Line : 4000 WAKE FOREST RD STE 200
Second Line :
City : RALEIGH
State : NC
Zip : 27609-6859
Country : US
Telephone Number : 919-865-8710
Fax Number :
Provider Business Practice Location Address
First Line : 4000 WAKE FOREST RD STE 200
Second Line :
City : RALEIGH
State : NC
Zip : 27609-6859
Country : US
Telephone Number : 919-865-8710
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/31/2012
Last Update Date : 10/03/2018

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