Provider Demographics
NPI:1134814536
Name:ANDERSON, REBECCA JOY (LGPC, NCC)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:JOY
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LGPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10309 NOLAN DR
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-3509
Mailing Address - Country:US
Mailing Address - Phone:301-509-1498
Mailing Address - Fax:
Practice Address - Street 1:10309 NOLAN DR
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3509
Practice Address - Country:US
Practice Address - Phone:301-509-1498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-10
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP13723101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health