Provider Demographics
NPI:1538687074
Name:MCINTYRE, REBECCA SISLEY (LCSW)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:SISLEY
Last Name:MCINTYRE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 GIRALDA CT
Mailing Address - Street 2:
Mailing Address - City:CROZET
Mailing Address - State:VA
Mailing Address - Zip Code:22932-1594
Mailing Address - Country:US
Mailing Address - Phone:919-672-3928
Mailing Address - Fax:434-961-2556
Practice Address - Street 1:2 BOARS HEAD LN STE 130
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-4605
Practice Address - Country:US
Practice Address - Phone:919-672-3928
Practice Address - Fax:434-961-2556
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-05
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040084481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical