Provider Demographics
NPI:1689250508
Name:KLEIN, REBECCA SUE
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:SUE
Last Name:KLEIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 GREENVILLE BLVD SE STE B1
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-5758
Mailing Address - Country:US
Mailing Address - Phone:252-341-4192
Mailing Address - Fax:
Practice Address - Street 1:200 VALENCIA DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-6311
Practice Address - Country:US
Practice Address - Phone:252-341-4192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-22
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-21-48305103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst