Provider Demographics
NPI:1235858374
Name:REBIRTH NUTRITION COUNSELING LLC
Entity Type:Organization
Organization Name:REBIRTH NUTRITION COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARINA
Authorized Official - Middle Name:
Authorized Official - Last Name:PEARSALL
Authorized Official - Suffix:
Authorized Official - Credentials:MPH, RDN, LDN
Authorized Official - Phone:984-999-1617
Mailing Address - Street 1:128 N CHURTON ST
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NC
Mailing Address - Zip Code:27278-2534
Mailing Address - Country:US
Mailing Address - Phone:984-999-1617
Mailing Address - Fax:
Practice Address - Street 1:128 N CHURTON ST
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:NC
Practice Address - Zip Code:27278-2534
Practice Address - Country:US
Practice Address - Phone:984-999-1617
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-23
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service