1457482325 NPI number — REBECCA DENICE COLSON LPC

Table of content: REBECCA DENICE COLSON LPC (NPI 1457482325)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457482325 NPI number — REBECCA DENICE COLSON LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COLSON
Provider First Name:
REBECCA
Provider Middle Name:
DENICE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ADCOCK
Provider Other First Name:
REBECCA
Provider Other Middle Name:
DENICE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1457482325
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/26/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1944 BRANNAN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MCDONOUGH
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30253-4310
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-289-6981
Provider Business Mailing Address Fax Number:
770-898-0366

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1944 BRANNAN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MCDONOUGH
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30253-4310
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-289-6981
Provider Business Practice Location Address Fax Number:
678-289-6983
Provider Enumeration Date:
03/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  0960 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: LPC003717 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 003127202A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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