Provider Demographics
NPI:1770221384
Name:LAIL, REBEKAH H
Entity Type:Individual
Prefix:MS
First Name:REBEKAH
Middle Name:H
Last Name:LAIL
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 1:202 LANIER MILL CIR
Mailing Address - Street 2:
Mailing Address - City:OAKWOOD
Mailing Address - State:GA
Mailing Address - Zip Code:30566-3384
Mailing Address - Country:US
Mailing Address - Phone:704-692-8797
Mailing Address - Fax:
Practice Address - Street 1:202 LANIER MILL CIR
Practice Address - Street 2:
Practice Address - City:OAKWOOD
Practice Address - State:GA
Practice Address - Zip Code:30566-3384
Practice Address - Country:US
Practice Address - Phone:704-692-8797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-24
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARBT-22-213123106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician