Provider Demographics
NPI:1154087195
Name:SHELTON, REBEKAH (LPC)
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:
Last Name:SHELTON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 COMMONWEALTH BLVD E
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24112-2086
Mailing Address - Country:US
Mailing Address - Phone:276-632-1113
Mailing Address - Fax:276-632-0923
Practice Address - Street 1:445 COMMONWEALTH BLVD E
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-2086
Practice Address - Country:US
Practice Address - Phone:276-632-1113
Practice Address - Fax:276-632-0923
Is Sole Proprietor?:No
Enumeration Date:2021-11-15
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701010993101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional