Provider Demographics
NPI:1215561931
Name:EVANS, REBEKAH RUTH (MS, LPC)
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:RUTH
Last Name:EVANS
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 S PARK SQ NE STE H
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-8616
Mailing Address - Country:US
Mailing Address - Phone:404-494-0518
Mailing Address - Fax:
Practice Address - Street 1:142 S PARK SQ NE STE H
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-8616
Practice Address - Country:US
Practice Address - Phone:404-494-0518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-03
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC011364101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor