Provider Demographics
NPI:1669639928
Name:GALLA, REBECCA CLEGG (LPC)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:CLEGG
Last Name:GALLA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 CONCORD RD SE
Mailing Address - Street 2:STE 201
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-4375
Mailing Address - Country:US
Mailing Address - Phone:404-295-1359
Mailing Address - Fax:
Practice Address - Street 1:1330 CONCORD RD SE
Practice Address - Street 2:STE 201
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-4375
Practice Address - Country:US
Practice Address - Phone:404-295-1359
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC004898101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional