Provider Demographics
NPI:1508436650
Name:POPE, REBECCA HEATHER (LMHC)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:HEATHER
Last Name:POPE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1636 SHADOWOOD LN STE 120
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-2187
Mailing Address - Country:US
Mailing Address - Phone:904-725-9701
Mailing Address - Fax:
Practice Address - Street 1:1636 SHADOWOOD LN STE 120
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-2187
Practice Address - Country:US
Practice Address - Phone:904-725-9701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-30
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH12626101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health