Provider Demographics
NPI:1457482325
Name:COLSON, REBECCA DENICE (LPC)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:DENICE
Last Name:COLSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:DENICE
Other - Last Name:ADCOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:1944 BRANNAN RD
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-4310
Mailing Address - Country:US
Mailing Address - Phone:678-289-6981
Mailing Address - Fax:770-898-0366
Practice Address - Street 1:1944 BRANNAN RD
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-4310
Practice Address - Country:US
Practice Address - Phone:678-289-6981
Practice Address - Fax:678-289-6983
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0960101YP2500X
GALPC003717101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003127202AMedicaid