MEDICARE: REBECCA CROWE

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	101YP2500X	Professional Counselor	LPC005867	GA

General Provider Information

NPI Number	:	1588034029
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA CROWE

Provider Business Mailing Address
First Line	:	750 LONGLEAF BLVD STE D
Second Line	:
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30046-8459
Country	:	US
Telephone Number	:	678-409-1788
Fax Number	:	770-339-0090

Provider Business Practice Location Address
First Line	:	750 LONGLEAF BLVD STE D
Second Line	:
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30046-8459
Country	:	US
Telephone Number	:	678-409-1788
Fax Number	:	770-339-0090

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

Provider Enumeration Date	:	09/27/2015
Last Update Date	:	09/27/2015

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Directions to “ REBECCA CROWE ” Practice Location

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