Provider Demographics
NPI:1073176707
Name:FAIN, REBECCA (LPC, CCMHC, CPCS)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:FAIN
Suffix:
Gender:F
Credentials:LPC, CCMHC, CPCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2514 ABERCORN ST APT 208
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31401-9198
Mailing Address - Country:US
Mailing Address - Phone:912-712-6623
Mailing Address - Fax:
Practice Address - Street 1:2430 ABERCORN ST STE B
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31401-9131
Practice Address - Country:US
Practice Address - Phone:912-712-6623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-18
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC010897101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty