Provider Demographics
NPI:1073851903
Name:DEAN, REBECCA CAMPBELL (LAC, MAC, CACII)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:CAMPBELL
Last Name:DEAN
Suffix:
Gender:F
Credentials:LAC, MAC, CACII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1905 DUKE ST
Mailing Address - Street 2:P.O. BOX 311
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29902-4403
Mailing Address - Country:US
Mailing Address - Phone:843-255-6000
Mailing Address - Fax:843-255-9406
Practice Address - Street 1:124 BOARDWALK DR STE A
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:SC
Practice Address - Zip Code:29936-7994
Practice Address - Country:US
Practice Address - Phone:843-645-2770
Practice Address - Fax:843-645-2771
Is Sole Proprietor?:No
Enumeration Date:2013-01-28
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLAC634AC101YA0400X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)