MEDICARE: MS. REBECCA LYNNE OWENS LCSW

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
1	1041C0700X	Clinical Social Worker	C004519	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7410644	OTHER		AETNA
2	19PL9	OTHER	NC	BCBS

General Provider Information

NPI Number	:	1528041555
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. REBECCA LYNNE OWENS LCSW

Provider Business Mailing Address
First Line	:	2323 OASIS DR
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28409-5056
Country	:	US
Telephone Number	:	910-520-4904
Fax Number	:

Provider Business Practice Location Address
First Line	:	2323 OASIS DR
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28409-5056
Country	:	US
Telephone Number	:	910-520-4904
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/23/2005
Last Update Date	:	11/08/2019

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