Provider Demographics
NPI:1801856356
Name:CARROLL, REBECCA F (LPC)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:F
Last Name:CARROLL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1316
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:OR
Mailing Address - Zip Code:97365-0101
Mailing Address - Country:US
Mailing Address - Phone:541-961-2020
Mailing Address - Fax:541-272-5599
Practice Address - Street 1:1600 N COAST HWY STE 1620
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:OR
Practice Address - Zip Code:97365
Practice Address - Country:US
Practice Address - Phone:412-725-5885
Practice Address - Fax:541-272-5599
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-27
Last Update Date:2018-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR98-169101YM0800X
ORC4712101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500663453Medicaid