Provider Demographics
NPI:1437222395
Name:KINCAID, REBECCA JEANNE (MS, LPA)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:JEANNE
Last Name:KINCAID
Suffix:
Gender:F
Credentials:MS, LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2709 PINEDALE RD STE B
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-2018
Mailing Address - Country:US
Mailing Address - Phone:336-288-9900
Mailing Address - Fax:336-288-9900
Practice Address - Street 1:2709 PINEDALE RD STE B
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-2018
Practice Address - Country:US
Practice Address - Phone:336-288-9900
Practice Address - Fax:336-288-9900
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1681103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC046UCOtherBLUE CROSS BLUE SHIELD
NC6107045Medicaid