Provider Demographics
NPI:1790424141
Name:CARSON, REBECCA (MA, LPC, NCC)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:
Last Name:CARSON
Suffix:
Gender:F
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:COUNSELING FCS&D PLC
Other - Middle Name:
Other - Last Name:SOLE PROPRIETOR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:3606 PLYMOUTH PL
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24503-1305
Mailing Address - Country:US
Mailing Address - Phone:901-428-7645
Mailing Address - Fax:
Practice Address - Street 1:3606 PLYMOUTH PL
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24503-1305
Practice Address - Country:US
Practice Address - Phone:190-142-8764
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-02
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701009522101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty