Provider Demographics
NPI:1184726713
Name:MORRISON, REBECCA GAYLE (PHD)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:GAYLE
Last Name:MORRISON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:GAYLE
Other - Last Name:PALMER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:402 S GEORGIA AVENUE
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401
Mailing Address - Country:US
Mailing Address - Phone:304-267-6250
Mailing Address - Fax:
Practice Address - Street 1:134 W PICCADILLY ST
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-3916
Practice Address - Country:US
Practice Address - Phone:540-667-1389
Practice Address - Fax:540-667-1394
Is Sole Proprietor?:No
Enumeration Date:2006-09-03
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1099101YP2500X
VA0701002743101YP2500X
VA0810004374103TC0700X
WV1025103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA082464OtherCOMMUNITY HEALTH
VA192121OtherANTHEM BCBS