Provider Demographics
NPI:1689171878
Name:WEBB, REBECCA ROSE (CSC-AD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:ROSE
Last Name:WEBB
Suffix:
Gender:F
Credentials:CSC-AD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8900 FAIRLEE RD APT 1
Mailing Address - Street 2:
Mailing Address - City:CHESTERTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21620-3820
Mailing Address - Country:US
Mailing Address - Phone:410-251-2002
Mailing Address - Fax:
Practice Address - Street 1:202 COURSEVALL DR STE 104
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:MD
Practice Address - Zip Code:21617-2805
Practice Address - Country:US
Practice Address - Phone:443-262-0425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-12
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
MDSC2695101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD520202700Medicaid