Provider Demographics
NPI:1104216951
Name:WILCOX, REBECCA COMIRE (MED, MS, CAS)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:COMIRE
Last Name:WILCOX
Suffix:
Gender:
Credentials:MED, MS, CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:286 EVENTIDE DR
Mailing Address - Street 2:
Mailing Address - City:FLEMING ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32003-8186
Mailing Address - Country:US
Mailing Address - Phone:904-624-0882
Mailing Address - Fax:
Practice Address - Street 1:286 EVENTIDE DR
Practice Address - Street 2:
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-8186
Practice Address - Country:US
Practice Address - Phone:904-624-0882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-02
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA10449101YP2500X
FLSS1330103TS0200X
VAPPS-0601178103TS0200X
IN10279824103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional