Provider Demographics
NPI:1336286764
Name:COCKERHAM, REBEKAH EDNA
Entity Type:Individual
Prefix:MISS
First Name:REBEKAH
Middle Name:EDNA
Last Name:COCKERHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5215 VILLAGE CREST WAY APT 332
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37924-5035
Mailing Address - Country:US
Mailing Address - Phone:865-591-3676
Mailing Address - Fax:
Practice Address - Street 1:9111 CROSS PARK DR
Practice Address - Street 2:E475
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4506
Practice Address - Country:US
Practice Address - Phone:865-560-2551
Practice Address - Fax:865-560-2580
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health