Provider Demographics
NPI:1841931722
Name:FALLON, REBECCA (NBC-HWC)
Entity type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:
Last Name:FALLON
Suffix:
Gender:F
Credentials:NBC-HWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 VENUE WAY APT 9302
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-4566
Mailing Address - Country:US
Mailing Address - Phone:770-508-7712
Mailing Address - Fax:
Practice Address - Street 1:900 VENUE WAY APT 9302
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-4566
Practice Address - Country:US
Practice Address - Phone:770-508-7712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
A-3502411171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
Provider Identifiers
StateIdentifier IDID TypeIssuer
A-3502411OtherNATIONAL BOARD FOR HEALTH & WELLNESS COACHING