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NPI Code Detail

MEDICARE: REBECCA KELLY CARDONA LPC-MHSP, PHD

MEDICARE: REBECCA KELLY CARDONA LPC-MHSP, PHD
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
1101YP2500XProfessional Counselor1893TN

General Provider Information

NPI Number : 1831409168
Entity Type Code : Individual
Provider Name (Legal Business Name) : REBECCA KELLY CARDONA LPC-MHSP, PHD
Provider Business Mailing Address
First Line : PO BOX 408
Second Line :
City : WARTBURG
State : TN
Zip : 37887-0408
Country : US
Telephone Number : 423-346-6221
Fax Number : 423-346-3447
Provider Business Practice Location Address
First Line : 224 OLD MILL RD
Second Line :
City : WARTBURG
State : TN
Zip : 37887-4163
Country : US
Telephone Number : 423-346-6221
Fax Number : 423-346-3447
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/20/2010
Last Update Date : 10/10/2019

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