Provider Demographics
NPI:1093958266
Name:CONNER, REBECCA L (LCSW)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:L
Last Name:CONNER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1114 AUTUMN WOOD DR
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35216-5261
Mailing Address - Country:US
Mailing Address - Phone:205-310-0581
Mailing Address - Fax:
Practice Address - Street 1:1114 AUTUMN WOOD DR
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35216-5261
Practice Address - Country:US
Practice Address - Phone:205-310-0581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-16
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1773C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical