Provider Demographics
NPI:1083113211
Name:KOHAUT, REBECCA (EDS NCSP)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:
Last Name:KOHAUT
Suffix:
Gender:F
Credentials:EDS NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 BRADMERE LOOP
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23608-1090
Mailing Address - Country:US
Mailing Address - Phone:757-888-3216
Mailing Address - Fax:
Practice Address - Street 1:12465 WARWICK BLVD
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-3041
Practice Address - Country:US
Practice Address - Phone:757-591-4661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-02
Last Update Date:2018-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool