Provider Demographics
NPI:1871867929
Name:HALLAM, REBECCA E (LCSW-C)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:E
Last Name:HALLAM
Suffix:
Gender:F
Credentials:LCSW-C
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 83343
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20883-3343
Mailing Address - Country:US
Mailing Address - Phone:301-337-7211
Mailing Address - Fax:888-398-7137
Practice Address - Street 1:19625 ISLANDER ST
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-1020
Practice Address - Country:US
Practice Address - Phone:301-337-7211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-06
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD097111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical