Provider Demographics
NPI:1154364131
Name:HALTERMAN, REBECCA A (LCSW)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:A
Last Name:HALTERMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:ANN
Other - Last Name:REDFEARN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:21321 MARSH CREEK DR
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20148-4025
Mailing Address - Country:US
Mailing Address - Phone:703-723-1459
Mailing Address - Fax:
Practice Address - Street 1:4208 SIX FORKS RD
Practice Address - Street 2:BLDG 1, SUITE 305 A
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-5735
Practice Address - Country:US
Practice Address - Phone:800-632-6074
Practice Address - Fax:866-341-7509
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0052611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6106410Medicaid
NC2875611Medicare ID - Type UnspecifiedPROVIDER # WITH PARADIGM