Provider Demographics
NPI:1073081444
Name:NEWCOMER, REBECCA KAY (LCPC)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:KAY
Last Name:NEWCOMER
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:KAY
Other - Last Name:WOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:302 SECOND STREET
Mailing Address - Street 2:
Mailing Address - City:REDMON
Mailing Address - State:IL
Mailing Address - Zip Code:61949
Mailing Address - Country:US
Mailing Address - Phone:217-264-0113
Mailing Address - Fax:
Practice Address - Street 1:1101 E WINTER AVE
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832-2295
Practice Address - Country:US
Practice Address - Phone:217-651-6801
Practice Address - Fax:217-651-6802
Is Sole Proprietor?:No
Enumeration Date:2018-11-05
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.003068101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional