Provider Demographics
NPI:1023432374
Name:KAUFMAN, REBECCA (LPC)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:KAUFMAN
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 1:24 STONERIDGE CT
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-7915
Mailing Address - Country:US
Mailing Address - Phone:912-713-4416
Mailing Address - Fax:
Practice Address - Street 1:24 STONERIDGE CT
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-7915
Practice Address - Country:US
Practice Address - Phone:912-713-4416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-06
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA06444101YM0800X
VA0701006815101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health