Provider Demographics
NPI:1508942590
Name:NAGAISHI, REBECCA L (MSW, LCSW, LMFT)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:L
Last Name:NAGAISHI
Suffix:
Gender:F
Credentials:MSW, LCSW, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 LA VALE DR
Mailing Address - Street 2:
Mailing Address - City:CLEMMONS
Mailing Address - State:NC
Mailing Address - Zip Code:27012-9042
Mailing Address - Country:US
Mailing Address - Phone:336-722-8173
Mailing Address - Fax:336-724-6491
Practice Address - Street 1:610 COLISEUM DRIVE
Practice Address - Street 2:FAMILY SERVICES, INC
Practice Address - City:WINSTON-SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106
Practice Address - Country:US
Practice Address - Phone:336-722-8173
Practice Address - Fax:336-724-6491
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0000671041C0700X
NC286106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6003378Medicaid