Provider Demographics
NPI:1689738445
Name:MORE, REBECCA S (PHD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:S
Last Name:MORE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 OLD SPRING HOUSE LN
Mailing Address - Street 2:SUITE 310
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30338-6215
Mailing Address - Country:US
Mailing Address - Phone:404-932-0995
Mailing Address - Fax:
Practice Address - Street 1:1720 OLD SPRING HOUSE LN
Practice Address - Street 2:SUITE 310
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30338-6215
Practice Address - Country:US
Practice Address - Phone:404-932-0995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2009-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY001220103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist