Provider Demographics
NPI:1619798204
Name:LAWSON, REBEKAH M (PROVISIONAL LPC)
Entity type:Individual
Prefix:
First Name:REBEKAH
Middle Name:M
Last Name:LAWSON
Suffix:
Gender:F
Credentials:PROVISIONAL LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:656 GIVENS RUN RD
Mailing Address - Street 2:
Mailing Address - City:UPPERGLADE
Mailing Address - State:WV
Mailing Address - Zip Code:26266-9719
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10003 WEBSTER RD
Practice Address - Street 2:
Practice Address - City:CAMDEN ON GAULEY
Practice Address - State:WV
Practice Address - Zip Code:26208-7713
Practice Address - Country:US
Practice Address - Phone:304-226-5725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-17
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV968101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health