Provider Demographics
NPI:1740819978
Name:GILLAM, MS, LPC, ATR-BC, REBECCA LYN (LPC, ATR-BC)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:LYN
Last Name:GILLAM, MS, LPC, ATR-BC
Suffix:
Gender:F
Credentials:LPC, ATR-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7051 BROOKFIELD PLZ
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22150-9998
Mailing Address - Country:US
Mailing Address - Phone:571-354-0416
Mailing Address - Fax:
Practice Address - Street 1:8626 LEE HWY STE 200
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-2135
Practice Address - Country:US
Practice Address - Phone:571-354-0416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-08
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional