Provider Demographics
NPI:1699563023
Name:ATWATER, REBEKAH (CLC, PCD)
Entity type:Individual
Prefix:
First Name:REBEKAH
Middle Name:
Last Name:ATWATER
Suffix:
Gender:
Credentials:CLC, PCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43221 VALIANT DR
Mailing Address - Street 2:
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20152-3425
Mailing Address - Country:US
Mailing Address - Phone:703-662-1769
Mailing Address - Fax:
Practice Address - Street 1:8245 BOONE BLVD
Practice Address - Street 2:
Practice Address - City:TYSONS
Practice Address - State:VA
Practice Address - Zip Code:22182-3828
Practice Address - Country:US
Practice Address - Phone:703-662-1769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-26
Last Update Date:2025-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA284018174N00000X
VA14811374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No174N00000XOther Service ProvidersLactation Consultant, Non-RN