Provider Demographics
NPI:1023359874
Name:WATERS, REBECCA C (LCMHCA)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:C
Last Name:WATERS
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 OLD US 74 HWY
Mailing Address - Street 2:
Mailing Address - City:BOSTIC
Mailing Address - State:NC
Mailing Address - Zip Code:28018-6781
Mailing Address - Country:US
Mailing Address - Phone:828-447-4055
Mailing Address - Fax:
Practice Address - Street 1:809 N LAFAYETTE ST STE A
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-3886
Practice Address - Country:US
Practice Address - Phone:704-284-0554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-04
Last Update Date:2020-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5440101YM0800X
NCA16068101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health