Provider Demographics
NPI:1831409168
Name:CARDONA, REBECCA KELLY (LPC-MHSP, PHD)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:KELLY
Last Name:CARDONA
Suffix:
Gender:F
Credentials:LPC-MHSP, PHD
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:KELLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC-MHSP
Mailing Address - Street 1:PO BOX 408
Mailing Address - Street 2:
Mailing Address - City:WARTBURG
Mailing Address - State:TN
Mailing Address - Zip Code:37887-0408
Mailing Address - Country:US
Mailing Address - Phone:423-346-6221
Mailing Address - Fax:423-346-3447
Practice Address - Street 1:224 OLD MILL RD
Practice Address - Street 2:
Practice Address - City:WARTBURG
Practice Address - State:TN
Practice Address - Zip Code:37887-4163
Practice Address - Country:US
Practice Address - Phone:423-346-6221
Practice Address - Fax:423-346-3447
Is Sole Proprietor?:No
Enumeration Date:2010-10-20
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1893101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional