Provider Demographics
NPI:1710439013
Name:BEAVER, REBECCA ELAINE (LPC, AADC)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:ELAINE
Last Name:BEAVER
Suffix:
Gender:F
Credentials:LPC, AADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 LOWER COACH RD
Mailing Address - Street 2:
Mailing Address - City:HURRICANE
Mailing Address - State:WV
Mailing Address - Zip Code:25526-8601
Mailing Address - Country:US
Mailing Address - Phone:304-562-2418
Mailing Address - Fax:304-526-2638
Practice Address - Street 1:5 LOWER COACH RD
Practice Address - Street 2:
Practice Address - City:HURRICANE
Practice Address - State:WV
Practice Address - Zip Code:25526-8601
Practice Address - Country:US
Practice Address - Phone:304-562-2418
Practice Address - Fax:304-526-2638
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-03
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2223101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health