Provider Demographics
NPI:1083255442
Name:LEE, REBECCA DEVEREAUX (MS, LMFT)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:DEVEREAUX
Last Name:LEE
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2522 BEVERLY DR
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN BRK
Mailing Address - State:AL
Mailing Address - Zip Code:35223-1116
Mailing Address - Country:US
Mailing Address - Phone:205-960-3432
Mailing Address - Fax:
Practice Address - Street 1:6 OFFICE PARK CIR STE 316
Practice Address - Street 2:
Practice Address - City:MOUNTAIN BRK
Practice Address - State:AL
Practice Address - Zip Code:35223-2542
Practice Address - Country:US
Practice Address - Phone:205-599-0149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-07
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALL523106H00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist